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Shiraishi Y, Kurita Y, Mori H, Oishi K, Matsukawa M. Timing of Worsening Renal Function in Patients Hospitalized for Heart Failure Exacerbation Who Were Being Treated With Intravenous Diuretic Therapy. Circ J 2024; 88:680-691. [PMID: 38143082 DOI: 10.1253/circj.cj-23-0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
BACKGROUND This retrospective observational study investigated the incidence of worsening renal function (WRF) in patients hospitalized for heart failure (HF) and treated with intravenous diuretics in Japan.Methods and Results: Associations between WRF at any point and HF treatments, and the effects of WRF on outcomes were evaluated (Diagnosis Procedure Combination database). Of 1,788 patients analyzed (mean [±SD] age 80.5±10.2 years; 54.4% male), 641 (35.9%) had WRF during a course of hospitalization for worsening HF: 208 (32.4%) presented with WRF before admission (BA-WRF; estimated glomerular filtration rate decreased by ≥25% from baseline at least once between 30 days prior to admission and admission); 44 (6.9%) had WRF that persisted before and after admission (P-WRF); and 389 (60.7%) had WRF develop after admission (AA-WRF). Delayed initial diuretic administration, higher maximum doses of intravenous diuretics during hospitalization, and diuretic readministration during hospitalization were associated with a significantly higher incidence of AA-WRF. Patients with WRF at any time point were at higher risk of death during hospitalization compared with patients without WRF, with adjusted hazard ratios of 3.56 (95% confidence interval [CI] 2.23-5.69) for BA-WRF, 3.23 (95% CI 2.21-4.71) for AA-WRF, and 13.16 (95% CI 8.19-21.15) for P-WRF (all P<0.0001). CONCLUSIONS Forty percent of WRF occurred before admission for acute HF; there was no difference in mortality between patients with BA-WRF and AA-WRF.
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Affiliation(s)
| | - Yuka Kurita
- Medical Affairs, Otsuka Pharmaceutical Co., Ltd
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Dhayat NA, Bonny O, Roth B, Christe A, Ritter A, Mohebbi N, Faller N, Pellegrini L, Bedino G, Venzin RM, Grosse P, Hüsler C, Koneth I, Bucher C, Del Giorno R, Gabutti L, Mayr M, Odermatt U, Buchkremer F, Ernandez T, Stoermann-Chopard C, Teta D, Vogt B, Roumet M, Tamò L, Cereghetti GM, Trelle S, Fuster DG. Hydrochlorothiazide and Prevention of Kidney-Stone Recurrence. N Engl J Med 2023; 388:781-791. [PMID: 36856614 DOI: 10.1056/nejmoa2209275] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Nephrolithiasis is one of the most common conditions affecting the kidney and is characterized by a high risk of recurrence. Thiazide diuretic agents are widely used for prevention of the recurrence of kidney stones, but data regarding the efficacy of such agents as compared with placebo are limited. Furthermore, dose-response data are also limited. METHODS In this double-blind trial, we randomly assigned patients with recurrent calcium-containing kidney stones to receive hydrochlorothiazide at a dose of 12.5 mg, 25 mg, or 50 mg once daily or placebo once daily. The main objective was to investigate the dose-response effect for the primary end point, a composite of symptomatic or radiologic recurrence of kidney stones. Radiologic recurrence was defined as the appearance of new stones on imaging or the enlargement of preexisting stones that had been observed on the baseline image. Safety was also assessed. RESULTS In all, 416 patients underwent randomization and were followed for a median of 2.9 years. A primary end-point event occurred in 60 of 102 patients (59%) in the placebo group, in 62 of 105 patients (59%) in the 12.5-mg hydrochlorothiazide group (rate ratio vs. placebo, 1.33; 95% confidence interval [CI], 0.92 to 1.93), in 61 of 108 patients (56%) in the 25-mg group (rate ratio, 1.24; 95% CI, 0.86 to 1.79), and in 49 of 101 patients (49%) in the 50-mg group (rate ratio, 0.92; 95% CI, 0.63 to 1.36). There was no relation between the hydrochlorothiazide dose and the occurrence of a primary end-point event (P = 0.66). Hypokalemia, gout, new-onset diabetes mellitus, skin allergy, and a plasma creatinine level exceeding 150% of the baseline level were more common among patients who received hydrochlorothiazide than among those who received placebo. CONCLUSIONS Among patients with recurrent kidney stones, the incidence of recurrence did not appear to differ substantially among patients receiving hydrochlorothiazide once daily at a dose of 12.5 mg, 25 mg, or 50 mg or placebo once daily. (Funded by the Swiss National Science Foundation and Inselspital; NOSTONE ClinicalTrials.gov number, NCT03057431.).
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Affiliation(s)
- Nasser A Dhayat
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Olivier Bonny
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Beat Roth
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Andreas Christe
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Alexander Ritter
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Nilufar Mohebbi
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Nicolas Faller
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Lisa Pellegrini
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Giulia Bedino
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Reto M Venzin
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Philipp Grosse
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Carina Hüsler
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Irene Koneth
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Christian Bucher
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Rosaria Del Giorno
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Luca Gabutti
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Michael Mayr
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Urs Odermatt
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Florian Buchkremer
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Thomas Ernandez
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Catherine Stoermann-Chopard
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Daniel Teta
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Bruno Vogt
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Marie Roumet
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Luca Tamò
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Grazia M Cereghetti
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Sven Trelle
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
| | - Daniel G Fuster
- From the Departments of Nephrology and Hypertension (N.A.D., N.F., B.V., L.T., G.M.C., D.G.F.), Urology (B.R.), and Radiology (A.C.), Inselspital, Bern University Hospital, and CTU Bern (M.R., S.T.), University of Bern, Bern, Service of Nephrology, Lausanne University Hospital, University of Lausanne, Lausanne (O.B.), the Department of Nephrology, University Hospital Zurich, Zurich (A.R., N.M.), the Department of Nephrology, Regional Hospital Lugano (L.P., G.B.), and Università della Svizzera Italiana (R.D.G., L.G.), Lugano, the Department of Nephrology, Cantonal Hospital Graubünden, Chur (R.M.V., P.G.), the Department of Nephrology and Transplantation Medicine, Cantonal Hospital St. Gallen, St. Gallen (C.H., I.K., C.B.), the Department of Internal Medicine, Regional Hospital of Bellinzona, Bellinzona (R.D.G., L.G.), the Medical Outpatient Department, University Hospital Basel, University of Basel, Basel (M.M.), the Department of Nephrology, Luzerner Kantonsspital LUKS, Lucerne (U.O.), the Division of Nephrology, Dialysis, and Transplantation, Cantonal Hospital Aarau, Aarau (F.B.), the Department of Nephrology, University Hospital Geneva, University of Geneva, Geneva (T.E., C.S.-C.), and the Nephrology Service, Centre Hospitalier du Valais Romand, Sion (D.T.) - all in Switzerland
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Kunitsu Y, Hira D, Morikochi A, Ueda T, Isono T, Morita SY, Terada T. Time until onset of acute kidney injury by combination therapy with “Triple Whammy” drugs obtained from Japanese Adverse Drug Event Report database. PLoS One 2022; 17:e0263682. [PMID: 35139129 PMCID: PMC8827454 DOI: 10.1371/journal.pone.0263682] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Acute kidney injury (AKI) associated with “Triple Whammy” drug therapy consisting of renin-angiotensin system inhibitors, diuretics, and nonsteroidal anti-inflammatory drugs (NSAIDs) has been reported. There have been no reports investigating “Triple Whammy” drug therapy and the time to AKI onset using adverse drug events report databases. The aim of this study was to determine the relationship between the time to AKI onset and treatment with “Triple Whammy” drug therapy. We analyzed AKI cases registered in the Japanese Adverse Drug Event Report database. The data were analyzed using the Kaplan–Meier approach, generalized Wilcoxon tests, and Weibull distribution. AKI was reported in 18,415 cases, of which 7,466 cases used Triple Whammy drugs. All combinations of Triple Whammy drugs were associated with significantly higher odds ratios for reporting AKI. In Weibull analysis, AKI onset was early for most combination patterns of Triple Whammy drugs. The Kaplan–Meier approach showed that the treatment duration to AKI onset was much shorter in cases using NSAIDs; median onsets, 8 days for triple combination, 7 days for NSAIDs added to renin-angiotensin system inhibitors, 9 days for NSAIDs added to diuretics, 6 days for diuretics added to NSAIDs, and 9 days for NSAIDs alone. AKI associated with Triple Whammy drugs is likely to occur in the early stages of treatment, especially with concomitant NSAIDs. Patients should be monitored for the occurrence of AKI within the first 2 weeks.
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Affiliation(s)
- Yuki Kunitsu
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Daiki Hira
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Sakyo-ku, Kyoto-shi, Kyoto, Japan
- College of Pharmaceutical Sciences, Ritsumeikan University, Kusatsu, Shiga, Japan
| | - Aya Morikochi
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Tomohiro Ueda
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Tetsuichiro Isono
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
| | - Shin-ya Morita
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- * E-mail: (SM); (TT)
| | - Tomohiro Terada
- Department of Pharmacy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
- Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Sakyo-ku, Kyoto-shi, Kyoto, Japan
- * E-mail: (SM); (TT)
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Abstract
BACKGROUND Little evidence has been available to support the use of thiazide diuretics to treat hypertension in patients with advanced chronic kidney disease. METHODS We randomly assigned patients with stage 4 chronic kidney disease and poorly controlled hypertension, as confirmed by 24-hour ambulatory blood-pressure monitoring, in a 1:1 ratio to receive chlorthalidone at an initial dose of 12.5 mg per day, with increases every 4 weeks if needed to a maximum dose of 50 mg per day, or placebo; randomization was stratified according to previous use of loop diuretics. The primary outcome was the change in 24-hour ambulatory systolic blood pressure from baseline to 12 weeks. Secondary outcomes were the change from baseline to 12 weeks in the urinary albumin-to-creatinine ratio, N-terminal pro-B-type natriuretic peptide level, plasma renin and aldosterone levels, and total body volume. Safety was also assessed. RESULTS A total of 160 patients underwent randomization, of whom 121 (76%) had diabetes mellitus and 96 (60%) were receiving loop diuretics. At baseline, the mean (±SD) estimated glomerular filtration rate was 23.2±4.2 ml per minute per 1.73 m2 of body-surface area and the mean number of antihypertensive medications prescribed was 3.4±1.4. At randomization, the mean 24-hour ambulatory systolic blood pressure was 142.6±8.1 mm Hg in the chlorthalidone group and 140.1±8.1 mm Hg in the placebo group and the mean 24-hour ambulatory diastolic blood pressure was 74.6±10.1 mm Hg and 72.8±9.3 mm Hg, respectively. The adjusted change in 24-hour systolic blood pressure from baseline to 12 weeks was -11.0 mm Hg (95% confidence interval [CI], -13.9 to -8.1) in the chlorthalidone group and -0.5 mm Hg (95% CI, -3.5 to 2.5) in the placebo group. The between-group difference was -10.5 mm Hg (95% CI, -14.6 to -6.4) (P<0.001). The percent change in the urinary albumin-to-creatinine ratio from baseline to 12 weeks was lower in the chlorthalidone group than in the placebo group by 50 percentage points (95% CI, 37 to 60). Hypokalemia, reversible increases in serum creatinine level, hyperglycemia, dizziness, and hyperuricemia occurred more frequently in the chlorthalidone group than in the placebo group. CONCLUSIONS Among patients with advanced chronic kidney disease and poorly controlled hypertension, chlorthalidone therapy improved blood-pressure control at 12 weeks as compared with placebo. (Funded by the National Heart, Lung, and Blood Institute and the Indiana Institute of Medical Research; CLICK ClinicalTrials.gov number, NCT02841280.).
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Affiliation(s)
- Rajiv Agarwal
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Arjun D Sinha
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Andrew E Cramer
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Mary Balmes-Fenwick
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Jazmyn H Dickinson
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Fangqian Ouyang
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
| | - Wanzhu Tu
- From the Division of Nephrology, Department of Medicine (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and the Department of Biostatistics and Health Data Science, Richard M. Fairbanks School of Public Health (F.O., W.T.), Indiana University School of Medicine, Richard L. Roudebush Veterans Affairs Medical Center (R.A., A.D.S., A.E.C., M.B.-F., J.H.D.), and Indiana University Center for Aging Research, Regenstrief Institute (W.T.) - all in Indianapolis
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Lee TH, Kuo G, Chang CH, Huang YT, Yen CL, Lee CC, Fan PC, Chen JJ. Diuretic effect of co-administration of furosemide and albumin in comparison to furosemide therapy alone: An updated systematic review and meta-analysis. PLoS One 2021; 16:e0260312. [PMID: 34851962 PMCID: PMC8635380 DOI: 10.1371/journal.pone.0260312] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It has been a matter of much debate whether the co-administration of furosemide and albumin can achieve better diuresis and natriuresis than furosemide treatment alone. There is inconsistency in published trials regarding the effect of this combination therapy. We, therefore, conducted this meta-analysis to explore the efficacy of furosemide and albumin co-administration and the factors potentially influencing the diuretic effect of such co-administration. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, Medline, and Cochrane databases. Prospective studies with adult populations which comparing the effect of furosemide and albumin co-administration with furosemide alone were included. The outcomes including diuretic effect and natriuresis effect measured by hourly urine output and hourly urine sodium excretion from both groups were extracted. Random effect model was applied for conducting meta-analysis. Subgroup analysis and sensitivity analysis were performed to explore potential sources of heterogeneity of treatment effects. RESULTS By including 13 studies with 422 participants, the meta-analysis revealed that furosemide with albumin co-administration increased urine output by 31.45 ml/hour and increased urine excretion by 1.76 mEq/hour in comparison to furosemide treatment alone. The diuretic effect of albumin and furosemide co-administration was better in participants with low baseline serum albumin levels (< 2.5 g/dL) and high prescribed albumin infusion doses (> 30 g), and the effect was more significant within 12 hours after administration. Diuretic effect of co-administration was better in those with baseline Cr > 1.2 mg/dL and natriuresis effect of co-administration was better in those with baseline eGFR < 60 ml/min/1.73m2. CONCLUSION Co-administration of furosemide with albumin might enhance diuresis and natriuresis effects than furosemide treatment alone but with high heterogeneity in treatment response. According to the present meta-analysis, combination therapy might provide advantages compared to the furosemide therapy alone in patients with baseline albumin levels lower than 2.5 g/dL or in patients receiving higher albumin infusion doses or in patients with impaired renal function. Owing to high heterogeneity and limited enrolled participants, further parallel randomized controlled trials are warranted to examine our outcome. REGISTRATION PROSEPRO ID: CRD42020211002; https://clinicaltrials.gov/.
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Affiliation(s)
- Tao Han Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail: (GK); (J-JC)
| | - Chih-Hsiang Chang
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yen Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chieh Li Yen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Cheng-Chia Lee
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei Chun Fan
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-Jin Chen
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- * E-mail: (GK); (J-JC)
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Wang T, Han Y, Song Y. Comparison of continuous infusion and intermittent boluses of furosemide in acute heart failure: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27108. [PMID: 34664834 PMCID: PMC8448006 DOI: 10.1097/md.0000000000027108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acute heart failure (HF) is a common cause of hospital admission. This study aims to compare continuous infusion and intermittent boluses of furosemide in treating acute HF. METHODS This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. Electronic databases including Web of Science, Embase, PubMed, Wanfang, Data, Scopus, Science Direct, and Cochrane Library will be searched in June 2021 by 2 independent reviewers. The main outcomes are post-treatment daily urine output, weight, length of stay, serum sodium, potassium, and creatinine. Two researchers conducted a quality assessment in strict accordance with the risk bias assessment tool recommended by the Cochrane Handbook Version5.3. We performed the meta-analysis by Stata version 10.0 software. RESULTS The results of this systematic review and meta-analysis will be published in a peer-reviewed journal. CONCLUSION The choice of furosemide regime in acute HF remains physician preference. Both bolus and continuous infusion yields satisfactory outcomes.
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7
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Hamo CE, Abdelmoneim SS, Han SY, Chandy E, Muntean C, Khan SA, Sunkesula P, Meykler M, Ramachandran V, Rosenberg E, Klem I, Sacchi TJ, Heitner JF. OUTpatient intravenous LASix Trial in reducing hospitalization for acute decompensated heart failure (OUTLAST). PLoS One 2021; 16:e0253014. [PMID: 34170908 PMCID: PMC8232441 DOI: 10.1371/journal.pone.0253014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospitalization for acute decompensated heart failure (ADHF) remains a major source of morbidity and mortality. The current study aimed to investigate the feasibility, safety, and efficacy of outpatient furosemide intravenous (IV) infusion following hospitalization for ADHF. METHODS In a single center, prospective, randomized, double-blind study, 100 patients were randomized to receive standard of care (Group 1), IV placebo infusion (Group 2), or IV furosemide infusion (Group 3) over 3h, biweekly for a one-month period following ADHF hospitalization. Patients in Groups 2/3 also received a comprehensive HF-care protocol including bi-weekly clinic visits for dose-adjusted IV-diuretics, medication adjustment and education. Echocardiography, quality of life and depression questionnaires were performed at baseline and 30-day follow-up. The primary outcome was 30-day re-hospitalization for ADHF. RESULTS Overall, a total of 94 patients were included in the study (mean age 64 years, 56% males, 69% African American). There were a total of 14 (15%) hospitalizations for ADHF at 30 days, 6 (17.1%) in Group 1, 7 (22.6%) in Group 2, and 1 (3.7%) in Group 3 (overall p = 0.11; p = 0.037 comparing Groups 2 and 3). Patients receiving IV furosemide infusion experienced significantly greater urine output and weight loss compared to those receiving placebo without any significant increase creatinine and no significant between group differences in echocardiography parameters, KCCQ or depression scores. CONCLUSION The use of a standardized protocol of outpatient IV furosemide infusion for a one-month period following hospitalization for ADHF was found to be safe and efficacious in reducing 30-day re-hospitalization.
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Affiliation(s)
- Carine E. Hamo
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sahar S. Abdelmoneim
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Seol Young Han
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Elizabeth Chandy
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Cornelia Muntean
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Saadat A. Khan
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Prasanthi Sunkesula
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Marcella Meykler
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Vidhya Ramachandran
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Emelie Rosenberg
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - Igor Klem
- The Duke Clinical Research Institute, Durham, North Carolina, United States of America
| | - Terrence J. Sacchi
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
| | - John F. Heitner
- Division of Cardiology, Brooklyn New York-Presbyterian Hospital, Brooklyn, New York, United States of America
- * E-mail:
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8
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Wang SH, Xu JT, Hu XJ, Cui J. Acupuncture combined with western medicine for the treatment of hypertension: A protocol for an updated systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e26412. [PMID: 34160427 PMCID: PMC8238323 DOI: 10.1097/md.0000000000026412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Hypertension is a kind of cardiovascular syndrome with the main clinical manifestation of continuous increase of systemic arterial blood pressure. Hypertension coexists with other cardiovascular risk factors and is an important risk factor for cardiovascular and cerebrovascular diseases. Acupuncture is an important part of Traditional Chinese Medicine intervention. The antihypertensive effect of acupuncture on hypertension is based on the neuroendocrine system, characterized by multichannel and multitarget. This study aims to provide latest and updated proof of systematic review to assess the effectiveness and safety of acupuncture for hypertension. METHODS We will systematically search 9 databases from their inceptions to February 2021. Only randomized controlled trials of acupuncture combined with western medicine in the treatment of hypertension will meet the inclusion criteria. The main outcome measures we focus on include clinical efficacy, syndrome efficacy, Traditional Chinese Medicine syndrome score, diastolic and systolic blood pressure changes, blood pressure variability, heart rate variability, pulse rate variability, and adverse reactions. The research screening, data extraction, and risk of bias assessment will be employed by 2 reviewers independently, and disagreement will be decided by a third senior reviewer. The Revman 5.3 software will be used for meta-analysis. The confidence of proof will be rated adopting grading of recommendations assessment, development and evaluation tool and methodological quality of this research will be assessed using assessment of multiple systematic reviews-2 and risk of bias in systematic reviews. The publication quality will be evaluated by preferred reporting items for systematic reviews and meta-analyses (PRISMA). RESULTS This systematic review (SR) will provide evidence-based medical evidence for hypertension therapy by acupuncture combined with western medicine and we will submit the findings of this SR for peer-review publication. CONCLUSIONS This SR will provide latest and updated summary proof for assessing the effectiveness and safety of acupuncture for hypertension. REGISTRATION NUMBER INPLASY 202150047.
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Affiliation(s)
| | | | - Xiao-Juan Hu
- Shanghai Innovation Center of TCM Health Service, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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9
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Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, Filippatos G, Nowak R, Hogan C, Kontos MC, Cannon CM, Müeller GA, Birkhahn R, Taub P, Vilke GM, Barnett O, McDonald K, Mahon N, Nuñez J, Briguori C, Passino C, Maisel A, Murray PT. Relation of Decongestion and Time to Diuretics to Biomarker Changes and Outcomes in Acute Heart Failure. Am J Cardiol 2021; 147:70-79. [PMID: 33617811 DOI: 10.1016/j.amjcard.2021.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 01/03/2023]
Abstract
Prompt treatment may mitigate the adverse effects of congestion in the early phase of heart failure (HF) hospitalization, which may lead to improved outcomes. We analyzed 814 acute HF patients for the relationships between time to first intravenous loop diuretics, changes in biomarkers of congestion and multiorgan dysfunction, and 1-year composite end point of death or HF hospitalization. B-type natriuretic peptide (BNP), high sensitivity cardiac troponin I (hscTnI), urine and serum neutrophil gelatinase-associated lipocalin, and galectin 3 were measured at hospital admission, hospital day 1, 2, 3 and discharge. Time to diuretics was not correlated with the timing of decongestion defined as BNP decrease ≥ 30% compared with admission. Earlier BNP decreases but not time to diuretics were associated with earlier and greater decreases in hscTnI and urine neutrophil gelatinase-associated lipocalin, and lower incidence of the composite end point. After adjustment for confounders, only no BNP decrease at discharge was significantly associated with mortality but not the composite end point (p = 0.006 and p = 0.062, respectively). In conclusion, earlier time to decongestion but not the time to diuretics was associated with better biomarker trajectories. Residual congestion at discharge rather than the timing of decongestion predicted a worse prognosis.
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Affiliation(s)
- Yu Horiuchi
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California; Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Nicholas Wettersten
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Christian Mueller
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gerasimos Filippatos
- Department of Cardiology, Athens University Hospital Attikon, University of Athens, Athens, Greece
| | - Richard Nowak
- Department of Emergency Medicine, Henry Ford Hospital System, Detroit, Michigan
| | - Christopher Hogan
- Division of Emergency Medicine and Acute Care Surgical Services, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Michael C Kontos
- Division of Cardiology, VCU Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Chad M Cannon
- Department of Emergency Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Gerhard A Müeller
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, University of Göttingen, Göttingen, Germany
| | - Robert Birkhahn
- Department of Emergency Medicine, New York Methodist Hospital, New York, New York
| | - Pam Taub
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Gary M Vilke
- Department of Emergency Medicine, University of California San Diego, La Jolla, California
| | - Olga Barnett
- Division of Cardiology, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Kenneth McDonald
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, St Vincent's University Hospital, Dublin, Ireland
| | - Niall Mahon
- Department of Cardiology, School of Medicine, University College Dublin, Dublin, Ireland; Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Julio Nuñez
- Department of Cardiology, Valencia University Hospital, INCLIVA, Valencia, Spain; Centro de Investigación Biomédica en Red (CIBER) in Cardiovascular Diseases, Madrid, Spain
| | - Carlo Briguori
- Department of Cardiology, Mediterranea Cardiocentro, Naples, Italy
| | - Claudio Passino
- Department of Cardiology and Cardiovascular Medicine, Fondazione Gabriele Monasterio, Pisa, Italy
| | - Alan Maisel
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, California
| | - Patrick T Murray
- Department of Medicine, School of Medicine, University College Dublin, Dublin, Ireland.
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10
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Shimamura Y, Abe K, Maeda T, Ogawa Y, Takizawa H, Ishigami J, Matsushita K. Association between diuretic administration before diagnosis and incidence of acute kidney injury in patients with minimal change disease: A single-center observational study. Medicine (Baltimore) 2021; 100:e25845. [PMID: 33950999 PMCID: PMC8104140 DOI: 10.1097/md.0000000000025845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/18/2021] [Indexed: 01/04/2023] Open
Abstract
We examined the association between diuretic administration before the diagnosis of minimal change disease and the incidence of acute kidney injury. Moreover, we examined whether the use of diuretics affected the time to complete remission in adults with such disease.The present study was a single-center, retrospective, observational cohort study. We included 107 patients with biopsy-proven minimal change disease who were treated at a tertiary referral center in Japan between January 1, 2000 and March 31, 2019. All biopsy specimens were examined by a board-certified renal pathologist. The patients were considered to have minimal change disease when the kidney biopsy specimen had no glomerular lesions or only mild focal mesangial prominence (not exceeding 3 or 4 cells per segment) by light microscopy and/or foot process effacement by electron microscopy. Logistic regression and Kaplan-Meier curve analyses were performed, comparing the data of patients who received diuretics or not.The median age was 47 (28-66) years, 52% of patients were women, and the median proteinuria dosage was 8.3 (5.3-11.2) g/d. When minimal change disease was diagnosed, 27% of patients were taking diuretics. Within 30 days after the diagnosis, acute kidney injury occurred in 27% of patients. On multivariable logistic regression analysis, the use of diuretics was significantly associated with a higher risk of acute kidney injury. The use of diuretics was also associated with a longer time to complete remission.Diuretic administration can be associated with an elevated acute kidney injury risk and longer remission time in adult patients with newly diagnosed minimal change disease.
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Affiliation(s)
| | - Koki Abe
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Takuto Maeda
- Department of Nephrology, Teine Keijinkai Medical Center
| | - Yayoi Ogawa
- Hokkaido Renal Pathology Center, Sapporo, Hokkaido, Japan
| | | | - Junichi Ishigami
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Duarte AL, Reis-Pina P. [Thiazide Diuretics and the Frail Elderly Patient: Beyond Guidelines]. ACTA MEDICA PORT 2021; 34:403-404. [PMID: 34253284 DOI: 10.20344/amp.14856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | - Paulo Reis-Pina
- Unidade de Cuidados Paliativos "Bento Menni". Casa de Saúde da Idanha. Sintra. Escola de Medicina. Universidade do Minho. Braga. Faculdade de Medicina. Universidade de Lisboa. Lisboa. Portugal
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12
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Covic A, Copur S, Tapoi L, Afsar B, Ureche C, Siriopol D, Nistor I, Kanbay M. Efficiency of Hypertonic Saline in the Management of Decompensated Heart Failure: A Systematic Review and Meta-Analysis of Clinical Studies. Am J Cardiovasc Drugs 2021; 21:331-347. [PMID: 33210263 DOI: 10.1007/s40256-020-00453-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Acute decompensated heart failure (ADHF), with an incidence of 1-2%, is a clinical syndrome with significant morbidity and mortality despite therapeutic advancements and ongoing clinical trials. A recent therapeutic approach to patients with ADHF includes combination therapy with hypertonic saline solution (HSS) and furosemide, based on the hypothesis that resistance to loop diuretics occurs because of achievement of plateau in water and sodium excretion in patients receiving long-term loop diuretic therapy. OBJECTIVE Our aim was to conduct a meta-analysis to evaluate the efficiency of combination HSS plus furosemide therapy in patients with ADHF in terms of mortality, readmissions, length of hospital stay, kidney function, urine output, body weight, and B-type natriuretic peptide (BNP). METHODS A total of 14 studies-four observational and ten randomized studies (total 3398 patients)-were included in the meta-analysis. RESULTS Our results demonstrate the superiority of combination HSS plus furosemide therapy over furosemide alone in terms of kidney function preservation (mean creatinine difference - 0.33 mg/dL; P < 0.00001), improved diuresis (mean difference [MD] 581.94 mL/24 h; P < 0.00001) and natriuresis (MD 57.19; P < 0.00001), weight loss (MD 0.99 kg; P < 0.00001), duration of hospital stay (MD - 2.72 days; P < 0.00001), readmissions (relative risk 0.63; P = 0.01), and mortality (relative risk 0.55; P < 0.00001). However, no difference in BNP levels was detected (MD 19.88 pg/mL; P = 0.50). CONCLUSION Despite the heterogeneity and possible risk of bias among the studies, results appear promising on multiple aspects. A clear need exists for future randomized controlled trials investigating the role of combination HSS plus furosemide therapy to clarify these effects and their possible mechanisms.
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Affiliation(s)
- Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Laura Tapoi
- Cardiovascular Diseases Institute, Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Carina Ureche
- Cardiovascular Diseases Institute, Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Dimitrie Siriopol
- Department of Nephrology, Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
| | - Ionut Nistor
- Department of Nephrology, Grigore T. Popa' University of Medicine and Pharmacy, Iasi, Romania
- Nephrology Clinic, Dialysis and Renal Transplant Centre, "Dr C. I. Parhon" Hospital, Iasi, Romania
- Evidence Based Medicine and Research Methodology Center, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, 34010, Istanbul, Turkey.
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Mengesha B, Levi D, Kroonenberg M, Koren R, Golik A, Koren S. The Prevalence of Hypomagnesemia in Hospitalized Type 2 Diabetic Patients Treated with Diuretics and/or Proton Pump Inhibitors. Isr Med Assoc J 2021; 23:245-250. [PMID: 33899358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Hypomagnesemia (serum magnesium level < 1.7 mg/dl) occurs more frequently in patients with type 2 diabetes mellitus (T2DM).Serum magnesium levels are not routinely tested in hospitalized patients, including in hospitalized patients with T2DM. OBJECTIVES To evaluate the prevalence of hypomagnesemia among hospitalized T2DM patients treated with proton pump inhibitors (PPIs) and/or diuretics. METHODS A total of 263 T2DM patients hospitalized in general departments were included in the study and were further divided into four groups: group 1 (patients not treated with PPIs or diuretics), group 2 (patients treated with PPIs), group 3 (patients treated with diuretics), and group 4 (patients treated with both PPIs and diuretics). Blood and urine samples were taken during the first 24 hours of admission. Electrocardiogram was performed on admission. RESULTS Of the 263 T2DM patients, 58 (22.1%) had hypomagnesemia (serum magnesium level < 1.7 mg/dl). Patients in group 2 had the lowest mean serum magnesium level (1.79 mg/dl ± 0.27). Relatively more patients with hypomagnesemia were found in group 2 compared to the other groups, although a statistically significant difference was not observed. Significantly more patients in group 3 and 4 had chronic renal failure. Patients with hypomagnesemia had significantly lower serum calcium levels. CONCLUSIONS Hospitalized T2DM patients under PPI therapy are at risk for hypomagnesemia and hypocalcemia.
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Affiliation(s)
- Bethlehem Mengesha
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daniela Levi
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Kroonenberg
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Koren
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahuva Golik
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomit Koren
- Department of Internal Medicine A, Assaf Harofeh Medical Center, Zerifin, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Figlioli F, Bianco A, Thomas E, Stajer V, Korovljev D, Trivic T, Maksimovic N, Drid P. Rapid Weight Loss Habits before a Competition in Sambo Athletes. Nutrients 2021; 13:nu13041063. [PMID: 33805862 PMCID: PMC8064378 DOI: 10.3390/nu13041063] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Like other combat sports, sambo has competition rules that divide athletes into categories based on gender, age and weight. Athletes in combat sports often resort to rapid weight loss (RWL) methods to be more competitive in lower weight categories and gain an advantage against lighter, smaller and weaker competitors. The aim of this study was to examine the methodology implemented by two different sambo age categories, junior and senior athletes, in order to attain RWL. METHODS The sample consisted of 103 male sambo elite athletes (seniors/juniors: age 28.5 ± 4.3/18.9 ± 0.8; height (m): 1.7 ± 0.1/1.8 ± 0.1; weight (kg): 76.3 ± 17.8/74.4 ± 16.3; BMI (kg/m2): 25.0 ± 3.8/23.7 ± 3.9) who completed a survey on RWL. RESULTS Athletes reported losing a mean of 5 kg starting approximately 12 days before a competition. The most common methodology reported by senior and junior sambo athletes was gradually increasing dieting, followed by sauna and plastic suit training. Less common methods adopted were laxatives, diuretics, the use of diet pills and vomiting. There were significant group differences for sauna and diet pill ingestion. Coaches and parents are influential people in the lives of athletes concerning the weight loss strategy to be adopted. CONCLUSIONS This study's results unequivocally confirm the prevalent practice of RWL in both senior and junior sambo athletes. Although athletes prevalently chose "less harmful" methods, there is a need to inform parents and coaches of the risks and benefits of RWL.
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Affiliation(s)
- Flavia Figlioli
- Sport and Exercise Sciences Research Unit, University of Palermo, 90144 Palermo, Italy; (F.F.); (A.B.); (E.T.)
| | - Antonino Bianco
- Sport and Exercise Sciences Research Unit, University of Palermo, 90144 Palermo, Italy; (F.F.); (A.B.); (E.T.)
| | - Ewan Thomas
- Sport and Exercise Sciences Research Unit, University of Palermo, 90144 Palermo, Italy; (F.F.); (A.B.); (E.T.)
| | - Valdemar Stajer
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (D.K.); (T.T.); (N.M.)
| | - Darinka Korovljev
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (D.K.); (T.T.); (N.M.)
| | - Tatjana Trivic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (D.K.); (T.T.); (N.M.)
| | - Nebojsa Maksimovic
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (D.K.); (T.T.); (N.M.)
| | - Patrik Drid
- Faculty of Sport and Physical Education, University of Novi Sad, 21000 Novi Sad, Serbia; (V.S.); (D.K.); (T.T.); (N.M.)
- Correspondence:
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Commander SJ, Wu H, Boakye-Agyeman F, Melloni C, Hornik CD, Zimmerman K, Al-Uzri A, Mendley SR, Harper B, Cohen-Wolkowiez M, Hornik CP. Pharmacokinetics of Hydrochlorothiazide in Children: A Potential Surrogate for Renal Secretion Maturation. J Clin Pharmacol 2021; 61:368-377. [PMID: 33029806 PMCID: PMC8232568 DOI: 10.1002/jcph.1739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/24/2020] [Indexed: 12/26/2022]
Abstract
Hydrochlorothiazide (HCTZ) is a thiazide diuretic used in adults and children for the treatment of hypertension and edema. The pharmacokinetic (PK) properties of HCTZ in children are not well characterized, particularly among children with obesity who frequently suffer from hypertension and may, therefore, benefit from HCTZ therapy. HCTZ is excreted in the kidney via organic anion transporters 1 and 3 (OAT1 and OAT3). The ontogeny of OAT1 and OAT3 remain unknown, but HCTZ clearance may serve as a surrogate marker of OAT1 and OAT3 maturation. Population PK modeling was performed in NONMEM, and the model was leveraged to conduct dose-exposure simulations. This study examined 83 plasma samples from 49 participants (69% male) taking enteral HCTZ. The median (range) postnatal age was 6.7 years (0.03-19.5 years), and 17 (34%) participants were obese or morbidly obese. The median (range) dose of HCTZ was 0.654 mg/kg (0.11-1.8 kg) and the median number of doses recorded per participant was 5 (1-8). HCTZ PK was well characterized by a 1-compartment PK model. Body weight and a maturation model based on postmenstrual age were significant covariates for apparent clearance, but the presence of obesity was not. Dosing simulations were performed with a standardized 1mg/kg. Simulated exposure (area under the curve and maximum HCTZ concentrations) decreased with age and was likely due to older children receiving the maximum absolute doses of HCTZ. Further studies with more patients in each age group are required to confirm these PK findings of HCTZ in the children.
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Affiliation(s)
- Sarah Jane Commander
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Huali Wu
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Felix Boakye-Agyeman
- Department of Pharmacology and Cancer Biology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chiara Melloni
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Chi Dang Hornik
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kanecia Zimmerman
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Amira Al-Uzri
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA
| | - Susan R Mendley
- Department of Pediatrics and Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Barrie Harper
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Michael Cohen-Wolkowiez
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Christoph P Hornik
- Duke Clinical Research Institute, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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16
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Verhestraeten C, Weijers G, Debleu D, Ciarka A, Goethals M, Droogmans S, Maris M. Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement. PLoS One 2021; 15:e0244485. [PMID: 33382755 PMCID: PMC7775077 DOI: 10.1371/journal.pone.0244485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023] Open
Abstract
Aims Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. Methods and results The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Conclusions Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.
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Affiliation(s)
| | - Gijs Weijers
- Department of Cardiology, Centre Hospitalier Bois de l’Abbaye, Seraing, Belgium
| | | | - Agnieszka Ciarka
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
- Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marc Goethals
- Department of Cardiology, OLV Hospital Aalst, Aalst, Belgium
| | - Steven Droogmans
- Department of Cardiology, Centrum Voor Hart-en Vaatziekten, Jette, Belgium
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17
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Affiliation(s)
- M Adam Ali
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK.
| | - Matthew Colquhoun
- Cardiology Department, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, Harefield, UK
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18
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Freund Y, Cachanado M, Delannoy Q, Laribi S, Yordanov Y, Gorlicki J, Chouihed T, Féral-Pierssens AL, Truchot J, Desmettre T, Occelli C, Bobbia X, Khellaf M, Ganansia O, Bokobza J, Balen F, Beaune S, Bloom B, Simon T, Mebazaa A. Effect of an Emergency Department Care Bundle on 30-Day Hospital Discharge and Survival Among Elderly Patients With Acute Heart Failure: The ELISABETH Randomized Clinical Trial. JAMA 2020; 324:1948-1956. [PMID: 33201202 PMCID: PMC7672513 DOI: 10.1001/jama.2020.19378] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Clinical guidelines for the early management of acute heart failure in the emergency department (ED) setting are based on only moderate levels of evidence, with subsequent low adherence to these guidelines. OBJECTIVE To test the effect of an early guideline-recommended care bundle on short-term prognosis in older patients with acute heart failure in the ED. DESIGN, SETTING, AND PARTICIPANTS Stepped-wedge cluster randomized trial in 15 EDs in France of 503 patients 75 years and older with a diagnosis of acute heart failure in the ED from December 2018 to September 2019 and followed up for 30 days until October 2019. INTERVENTIONS A care bundle that included early intravenous nitrate boluses; management of precipitating factors, such as acute coronary syndrome, infection, or atrial fibrillation; and moderate dose of intravenous diuretics (n = 200). In the control group, patient care was left to the discretion of the treating emergency physician (n = 303). Each center was randomized to the order in which they switched to the "intervention period." After the initial 4-week control period for all centers, 1 center entered in the intervention period every 2 weeks. MAIN OUTCOMES AND MEASURES The primary end point was the number of days alive and out of hospital at 30 days. Secondary outcomes included 30-day all-cause mortality, 30-day cardiovascular mortality, unscheduled readmission, length of hospital stay, and kidney impairment. RESULTS Among 503 patients who were randomized (median age, 87 years; 298 [59%] women), 502 were analyzed. In the intervention group, patients received a median (interquartile range) of 27.0 (9-54) mg of intravenous nitrates in the first 4 hours vs 4.0 (2.0-6.0) mg in the control group (adjusted difference, 23.8 [95% CI, 13.5-34.1]). There was a significantly higher percentage of patients in the intervention group treated for their precipitating factors than in the control group (58.8% vs 31.9%; adjusted difference, 31.1% [95% CI, 14.3%-47.9%]). There was no statistically significant difference in the primary end point of the number of days alive and out of hospital at 30 days (median [interquartile range], 19 [0- 24] d in both groups; adjusted difference, -1.9 [95% CI, -6.6 to 2.8]; adjusted ratio, 0.88 [95% CI, 0.64-1.21]). At 30 days, there was no significant difference between the intervention and control groups in mortality (8.0% vs 9.7%; adjusted difference, 4.1% [95% CI, -17.2% to 25.3%]), cardiovascular mortality (5.0% vs 7.4%; adjusted difference, 2.1% [95% CI, -15.5% to 19.8%]), unscheduled readmission (14.3% vs 15.7%; adjusted difference, -1.3% [95% CI, -26.3% to 23.7%]), median length of hospital stay (8 d in both groups; adjusted difference, 2.5 [95% CI, -0.9 to 5.8]), and kidney impairment (1% in both groups). CONCLUSIONS AND RELEVANCE Among older patients with acute heart failure, use of a guideline-based comprehensive care bundle in the ED compared with usual care did not result in a statistically significant difference in the number of days alive and out of the hospital at 30 days. Further research is needed to identify effective treatments for acute heart failure in older patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03683212.
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Affiliation(s)
- Yonathan Freund
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Marine Cachanado
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Quentin Delannoy
- Emergency Department, Hôpital Pitié-Salpêtrière, Assistance Publique – Hôpitaux de Paris (APHP), Paris, France
| | - Said Laribi
- Emergency Department, Hôpital Bretonneau, Tours, France
| | - Youri Yordanov
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Emergency Department, Hôpital Saint Antoine, APHP, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Judith Gorlicki
- Emergency Department, Hôpital Avicenne, APHP, Bobigny, France
| | - Tahar Chouihed
- Emergency Department, Hôpital CHRU Nancy, INSERM U1116, Université de Lorraine, Vandoeuvre les Nancy, France
| | | | | | | | | | | | - Mehdi Khellaf
- Emergency Department, Hôpital Henri Mondor, APHP, Université Paris Est – INSERM U955, Créteil, France
| | - Olivier Ganansia
- Emergency Department, Hôpital Paris Saint Joseph, Groupe Hospitalier Paris Saint Joseph
| | - Jérôme Bokobza
- Emergency Department, Hôpital Cochin, APHP, Paris, France
| | - Frédéric Balen
- Emergency Department, Centre hospitalier Universitaire de Toulouse, Toulouse, France
| | - Sebastien Beaune
- Emergency Department, Hôpital Ambroise-Paré, APHP, Boulogne, Inserm U1144, Université de Paris, France
| | - Ben Bloom
- Emergency Department, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Tabassome Simon
- Sorbonne Université, Improving Emergency Care FHU, Paris, France
- Clinical Research Platform (URC-CRC-CRB), Hôpital Saint-Antoine, APHP, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesia, Burn and Critical Care, Hôpitaux Universitaires Saint Louis Lariboisière, FHU PROMICE INI-CRCT, AP-HP, France
- Université de Paris, Paris, France
- U942 – MASCOT- Inserm, Paris, France
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19
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Abstract
Diuretic resistance implies a failure to increase fluid and sodium (Na+) output sufficiently to relieve volume overload, edema, or congestion, despite escalating doses of a loop diuretic to a ceiling level (80 mg of furosemide once or twice daily or greater in those with reduced glomerular filtration rate or heart failure). It is a major cause of recurrent hospitalizations in patients with chronic heart failure and predicts death but is difficult to diagnose unequivocally. Pharmacokinetic mechanisms include the low and variable bioavailability of furosemide and the short duration of all loop diuretics that provides time for the kidneys to restore diuretic-induced Na+ losses between doses. Pathophysiological mechanisms of diuretic resistance include an inappropriately high daily salt intake that exceeds the acute diuretic-induced salt loss, hyponatremia or hypokalemic, hypochloremic metabolic alkalosis, and reflex activation of the renal nerves. Nephron mechanisms include tubular tolerance that can develop even during the time that the renal tubules are exposed to a single dose of diuretic, or enhanced reabsorption in the proximal tubule that limits delivery to the loop, or an adaptive increase in reabsorption in the downstream distal tubule and collecting ducts that offsets ongoing blockade of Na+ reabsorption in the loop of Henle. These provide rationales for novel strategies including the concurrent use of diuretics that block these nephron segments and even sequential nephron blockade with multiple diuretics and aquaretics combined in severely diuretic-resistant patients with heart failure.
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Affiliation(s)
- Christopher Stuart Wilcox
- From the Division of Nephrology and Hypertension and Hypertension Center, Georgetown University, Washington DC (C.S.W.)
| | | | - Bertram Pitt
- Division of Cardiology, University of Michigan, Ann Arbor, MI (B.P.)
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20
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Ma A. Evaluation of Alternate Patient Education Methods Regarding Treatment-Related Side Effects in Preparation for Radiation Therapy. J Med Imaging Radiat Sci 2020. [PMID: 32912757 PMCID: PMC7486210 DOI: 10.1016/j.jmir.2020.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Amy Ma
- Co-Présidente du Conseil consultatif de la famille, Montreal Children's Hospital, Hôpital de Montréal pour enfants; McGill University Health Centre, Membre du Comité des usagers du CUSM.
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21
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Ioannou A, Browne T, Jordan S, Metaxa S, Mandal AKJ, Missouris CG. Diuretic lounge and the impact on hospital admissions for treatment of decompensated heart failure. QJM 2020; 113:651-656. [PMID: 32251503 DOI: 10.1093/qjmed/hcaa114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/16/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Heart failure is a prevalent condition associated with frequent and costly hospital admissions. Hospitalizations are primarily related to worsening fluid retention and often require admission for decongestion with intravenous diuretics. OBJECTIVE To assess the safety of an outpatient intravenous diuresis service for heart failure patients, and its impact on emergency admissions and the cost of treatment. METHODS We conducted a prospective observational cohort registry study on patients referred to the diuretic lounge at our acute hospital between May 2017 and April 2018. RESULTS We analysed 245 patients treated in the diuretic lounge, of which 190 (77.6%) avoided hospitalization or any adverse events during the 60 days of follow up (77.6% vs. 22.4%; P < 0.001). The diuretic lounge service resulted in a significant decrease in emergency heart failure admissions compared to the previous 12 months (823 vs. 715 per annum; 68.6 ± 10.1 vs. 59.6 ± 14 per month; P = 0.04), and a numerical reduction in readmission rates (17.3% vs. 16.2%). The 13.1% decrease in admissions lead to financial savings of £315 497 per annum and £2921 per admission avoided. During the same time period, at the other acute hospital site in our trust, where no diuretic lounge service is available, the number of admissions did not significantly change (457 vs. 450 per annum; 37.5 ± 7.0 vs. 38.1 ± 7.6 per month; P = 0.81). CONCLUSION Ambulatory administration of intravenous diuretics reduces emergency admissions and is a safe and cost-effective alternative to treat acute decomposition in heart failure patients.
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Affiliation(s)
- A Ioannou
- Department of Cardiology, Royal Free Hospital, Royal Free NHS Foundation Trust, London, UK
| | - T Browne
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Jordan
- Department of Cardiology, Wrexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - S Metaxa
- Department of Cardiology, Wrexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - A K J Mandal
- Department of Cardiology, Wrexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
| | - C G Missouris
- Department of Cardiology, Wrexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- Medical School, University of Cyprus, Nicosia, Cyprus
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22
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Sawada Y, Shiraki M, Iwasa M, Hiraoka A, Nakanishi H, Karino Y, Nakajima T, Miyaaki H, Kawaguchi T, Yoshiji H, Okita K, Koike K. The effects of diuretic use and the presence of ascites on muscle cramps in patients with cirrhosis: a nationwide study. J Gastroenterol 2020; 55:868-876. [PMID: 32533302 DOI: 10.1007/s00535-020-01694-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Administration of diuretics and the presence of ascites in patients with cirrhosis were reported to be associated with muscle cramps; however, the clinical evidence is limited. This study aimed to determine whether muscle cramps are a diuretic-induced complication and whether ascites was a factor related to muscle cramp. METHODS A total of 1064 adult patients with cirrhosis were enrolled from 10 hospitals in Japan between June 2017 and December 2018. A questionnaire regarding cramps was completed by all patients. The ratio of extracellular water (ECW) was analyzed using the bioelectrical impedance analysis. Logistic regression analysis was performed to analyze the effects of diuretic administration and the ECW ratio on cramps. RESULTS Patients using diuretics had a higher incidence rate, higher frequency, stronger pain, and longer duration of cramps than those who did not. In the multivariate analysis, diuretic administration and the ECW ratio values ≥ 0.4 were not significantly associated with the presence, frequency, intensity, or duration of cramps. However, in the case of patients limited to Child-Pugh B or C, diuretic use was significantly correlated with the cramp frequency. CONCLUSIONS These results demonstrated that muscle cramps were not a complication of diuretic use in patients with cirrhosis; however, in those limited to Child-Pugh B or C, diuretic use was a factor that affected the frequency of cramps. Moreover, no association was found between the presence of ascites and cramps.
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Affiliation(s)
- Yasuhiko Sawada
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Makoto Shiraki
- Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Atsushi Hiraoka
- Gastroenterology Center, Ehime Prefectural Central Hospital, Matsuyama, Japan
| | - Hiroyuki Nakanishi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Yoshiyasu Karino
- Department of Hepatology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Tomoaki Nakajima
- Department of Hepatology, Sapporo Kosei General Hospital, Sapporo, Japan
| | - Hisamitsu Miyaaki
- Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | | | - Kazuhiko Koike
- Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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23
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Laslett DB, Cooper JM, Greenberg RM, Yesenosky GA, Basil A, Gangireddy C, Whitman IR. Electrolyte Abnormalities in Patients Presenting With Ventricular Arrhythmia (from the LYTE-VT Study). Am J Cardiol 2020; 129:36-41. [PMID: 32565090 DOI: 10.1016/j.amjcard.2020.04.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 11/15/2022]
Abstract
Electrolyte abnormalities are a known trigger for ventricular arrhythmia, and patients with heart disease on diuretic therapy may be at higher risk for electrolyte depletion. Our aim was to determine the prevalence of electrolyte depletion in patients presenting to the hospital with sustained ventricular tachycardia or ventricular fibrillation (VT/VF) versus heart failure, and identify risk factors for electrolyte depletion. Consecutive admissions to a tertiary care hospital for VT/VF were identified between July 2016 and October 2018 using the electronic medical record and compared with an equal number of consecutive admissions for heart failure (CHF). The study included 280 patients (140 patients in each group; mean age 63, 60% male, 59% African American). Average EF in the VT/VF and CHF groups was 30% and 33%, respectively. Hypokalemia (K < 3.5 mmol/L) and severe hypokalemia (K < 3.0 mmol/L) were present in 35.7% and 13.6%, respectively, of patients with VT/VF, compared to 12.9% and 2.7% of patients with CHF (p < 0.001 and p = 0.001, respectively, between groups). Hypomagnesemia was found in 7.8% and 5.8% of VT/VF and CHF patients, respectively (p = 0.46). Gastrointestinal illness and recent increases in diuretic dose were strongly associated with severe hypokalemia in VT/VF patients (odds ratio: 11.1 and 21.9, respectively; p < 0.001). In conclusion, hypokalemia is extremely common in patients presenting with VT/VF, much more so than in patients with CHF alone. Preceding gastrointestinal illness and increase in diuretic dose were strongly associated with severe hypokalemia in the VT/VF population, revealing a potential opportunity for early intervention and arrhythmia risk reduction.
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Affiliation(s)
- David B Laslett
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Joshua M Cooper
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard M Greenberg
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - George A Yesenosky
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Anuj Basil
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Chethan Gangireddy
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Isaac R Whitman
- Department of Medicine, Section of Cardiac Electrophysiology, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
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24
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Jackson AM, Dewan P, Anand IS, Bělohlávek J, Bengtsson O, de Boer RA, Böhm M, Boulton DW, Chopra VK, DeMets DL, Docherty KF, Dukát A, Greasley PJ, Howlett JG, Inzucchi SE, Katova T, Køber L, Kosiborod MN, Langkilde AM, Lindholm D, Ljungman CE, Martinez FA, O’Meara E, Sabatine MS, Sjöstrand M, Solomon SD, Tereshchenko S, Verma S, Jhund PS, McMurray JJ. Dapagliflozin and Diuretic Use in Patients With Heart Failure and Reduced Ejection Fraction in DAPA-HF. Circulation 2020; 142:1040-1054. [PMID: 32673497 PMCID: PMC7664959 DOI: 10.1161/circulationaha.120.047077] [Citation(s) in RCA: 120] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. In the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure), the sodium-glucose cotransporter 2 inhibitor dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction. We examined the efficacy and tolerability of dapagliflozin in relation to background diuretic treatment and change in diuretic therapy after randomization to dapagliflozin or placebo.
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Affiliation(s)
- Alice M. Jackson
- BHF Cardiovascular Research Centre, University of Glasgow, UK (A.M.J., P.D., K.F.D., P.S.J., J.J.V.M.)
| | - Pooja Dewan
- BHF Cardiovascular Research Centre, University of Glasgow, UK (A.M.J., P.D., K.F.D., P.S.J., J.J.V.M.)
| | - Inder S. Anand
- Department of Cardiology, University of Minnesota, Minneapolis (I.S.A.)
| | - Jan Bělohlávek
- 2nd Department of Internal Medicine, Cardiovascular Medicine, General Teaching Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic (J.B.)
| | - Olof Bengtsson
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D (O.B., A.M.L., D.L., M.S.), AstraZeneca, Gothenburg, Sweden
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center and University of Groningen, The Netherlands (R.A.d.B.)
| | - Michael Böhm
- Department of Medicine, Saarland University Hospital, Homburg–Saar, Germany (M.B.)
| | - David W. Boulton
- Quantitative Clinical Pharmacology, IMED Biotech Unit, Astra-Zeneca, Gaithersburg, MD (D.W.B.)
| | | | - David L. DeMets
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison (D.L.D.)
| | - Kieran F. Docherty
- BHF Cardiovascular Research Centre, University of Glasgow, UK (A.M.J., P.D., K.F.D., P.S.J., J.J.V.M.)
| | - Andrej Dukát
- 5th Department of Internal Medicine, Comenius University in Bratislava, Slovakia (A.D.)
| | - Peter J. Greasley
- Cardiovascular, Renal and Metabolism Translational Medicines Unit, Early Clinical Development, IMED Biotech Unit (P.J.G.), AstraZeneca, Gothenburg, Sweden
| | - Jonathan G. Howlett
- Cumming School of Medicine and Libin Cardiovascular Institute, University of Calgary, AB, Canada (J.G.W.)
| | - Silvio E. Inzucchi
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT (S.E.I.)
| | - Tzvetana Katova
- Clinic of Cardiology, National Cardiology Hospital, Sofia, Bulgaria (T.K.)
| | - Lars Køber
- Rigshospitalet Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.)
| | - Anna Maria Langkilde
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D (O.B., A.M.L., D.L., M.S.), AstraZeneca, Gothenburg, Sweden
| | - Daniel Lindholm
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D (O.B., A.M.L., D.L., M.S.), AstraZeneca, Gothenburg, Sweden
| | - Charlotta E.A. Ljungman
- Department of Molecular and Clinical Medicine and Cardiology, Sahlgrenska Academy, Gothenburg, Sweden (C.E.A.L.)
| | | | - Eileen O’Meara
- Department of Cardiology, Montreal Heart Institute, QC, Canada (E.O.)
| | - Marc S. Sabatine
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (M.S.S., S.D.S.)
| | - Mikaela Sjöstrand
- Late Stage Development, Cardiovascular, Renal and Metabolism, BioPharmaceuticals R&D (O.B., A.M.L., D.L., M.S.), AstraZeneca, Gothenburg, Sweden
| | - Scott D. Solomon
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA (M.S.S., S.D.S.)
| | - Sergey Tereshchenko
- Department of Myocardial Disease and Heart Failure, National Medical Research Center of Cardiology, Moscow, Russia (S.T.)
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael’s Hospital, University of Toronto, ON, Canada (S.V.)
| | - Pardeep S. Jhund
- BHF Cardiovascular Research Centre, University of Glasgow, UK (A.M.J., P.D., K.F.D., P.S.J., J.J.V.M.)
| | - John J.V. McMurray
- BHF Cardiovascular Research Centre, University of Glasgow, UK (A.M.J., P.D., K.F.D., P.S.J., J.J.V.M.)
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Agarwal R, Cramer AE, Balmes-Fenwick M, Sinha AD, Ouyang F, Tu W. Design and Baseline Characteristics of the Chlorthalidone in Chronic Kidney Disease (CLICK) Trial. Am J Nephrol 2020; 51:542-552. [PMID: 32663820 PMCID: PMC7409874 DOI: 10.1159/000508700] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypertension often accompanies chronic kidney disease (CKD), and diuretics are widely prescribed to reduce blood pressure (BP). Chlorthalidone (CTD) is a thiazide-like diuretic and an effective antihypertensive drug, yet little data exist to support its use in treating hypertension in individuals with advanced CKD. METHODS Chlorthalidone in Chronic Kidney Disease (CLICK) is a phase II, single-institution, multicenter, double-blind randomized control trial to test the hypothesis that CTD improves BP, through reduction of extracellular fluid volume, and results in target organ protection in patients with stage 4 CKD and poorly controlled hypertension. After a single-blind placebo run-in for 2 weeks and confirmation of hypertension by 24-h ambulatory blood pressure (ABP), patients are randomized to either placebo or CTD 12.5 mg once daily (QD) followed by dose escalation. Randomization is stratified by prior loop diuretic use, and the double-blind phase lasts 12 weeks. With a total of 160 patients, the study will have ≥80% power to detect a 6 mm Hg difference in systolic 24-h ABP between the 2 treatment groups. RESULTS Between June 2016 and October 2019, 131 patients have been randomized. The baseline characteristics are as follows: average age 65.8 years, 79% men, 36% Black, 79% with diabetes, mean eGFR 23.2 mL/min/1.73 m2, median urine albumin/creatinine ratio 923 mg/g, average number of BP medications 3.4, 60% on loop diuretics, and 24-h ABP averaged 141.7/73.8 mm Hg. CONCLUSION Among patients with stage 4 CKD and uncontrolled hypertension, CLICK should answer the question whether CTD is safe and effective.
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Affiliation(s)
- Rajiv Agarwal
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA,
| | - Andrew E Cramer
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Mary Balmes-Fenwick
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Arjun D Sinha
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA
| | - Fangqian Ouyang
- Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Bissell BD, Donaldson JC, Morris PE, Neyra JA. A narrative review of pharmacologic de-resuscitation in the critically ill. J Crit Care 2020; 59:156-162. [PMID: 32674002 DOI: 10.1016/j.jcrc.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 02/06/2023]
Abstract
Despite evidence highlighting harms of fluid overload, minimal guidance exists on counteraction via utilization of diuretics in the de-resuscitation phase. While diuretics have been shown to decrease net volume and improve clinical outcomes in the critically ill, a lack of standardization surrounding selection of diuretic regimen or monitoring of de-resuscitation exists. Current monitoring parameters of de-resuscitation often rely on clinical signs of fluid overload, end organ recovery and other biochemical surrogate markers which are often deemed unreliable. The majority of evidence suggests that achieving a net-negative fluid balance within 72 h after shock resolution may be of benefit; however, approaches to such goal are uncertain. Loop diuretics are a widely available type of diuretic for removal of volume in patients with sufficient kidney function, with the potential for adjunct diuretics in special circumstances. At present, administration of diuretics within the broad critically ill population fails to find uniformity and often efficacy. Given the lack of randomized controlled trials in this susceptible population, we aim to provide a thorough therapeutic understanding of diuretic pharmacotherapy which is necessary in order to achieve desired goal of fluid balance and improve overall outcomes.
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Affiliation(s)
- Brittany D Bissell
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 740 South Limestone, Lexington, Kentucky 40536, United States of America; University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, 789 South Limestone, Lexington, Kentucky 40536, United States of America.
| | - J Chris Donaldson
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, 789 South Limestone, Lexington, Kentucky 40536, United States of America.
| | - Peter E Morris
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, 740 South Limestone, Lexington, Kentucky 40536, United States of America.
| | - Javier A Neyra
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Nephrology, Bone and Mineral Metabolism, 740 South Limestone, Lexington, Kentucky 40536, United States of America.
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Wernly B, Heramvand N, Mirna M, Kelm M, Lichtenauer M, Dudzinski D, Jung C. Testing House of God's Law VII: Was the Fat Man Right? J Intensive Care Med 2020; 35:1141-1142. [PMID: 32602394 DOI: 10.1177/0885066620935817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bernhard Wernly
- Clinic of Internal Medicine II, Department of Cardiology, 31507Paracelsus Medical University of Salzburg, Austria
| | - Nadia Heramvand
- Cardiology Division, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Moritz Mirna
- Clinic of Internal Medicine II, Department of Cardiology, 31507Paracelsus Medical University of Salzburg, Austria
| | - Malte Kelm
- Cardiology Division, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Michael Lichtenauer
- Clinic of Internal Medicine II, Department of Cardiology, 31507Paracelsus Medical University of Salzburg, Austria
| | - David Dudzinski
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, 39064University of Düsseldorf, Germany
| | - Christian Jung
- Cardiology Division, 2348Massachusetts General Hospital, Boston, MA, USA
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Dong L, Wang F, Chen H, Lu Y, Zhang Y, Chen L, Cui Y. The efficacy and safety of diuretics on extracorporeal shockwave lithotripsy treatment of urolithiasis: A systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e20602. [PMID: 32569188 PMCID: PMC7310958 DOI: 10.1097/md.0000000000020602] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The aim of this systematic review and meta-analysis was to demonstrate the efficacy and safety of diuretics on extracorporeal shockwave lithotripsy (SWL) treatment of urolithiasis. METHODS The databases MEDLINE, EMBASE, and the Cochrane Controlled Trial Register of Controlled Trials from January 1980 until November 2019 were searched to identify randomized controlled trials that referred to the use of diuretics on extracorporeal SWL treatment of urolithiasis. RESULTS Six randomized controlled trials containing 1344 patients were included in this meta-analysis, which compared diuretics with placebo on extracorporeal SWL treatment of urolithiasis. In the analysis, we found that diuretics on extracorporeal SWL treatment were more effective for the management of urinary stones. Compared with placebo, patients who received diuretics during extracorporeal SWL treatment had significantly higher successful stone clearance rate (Odds ratio; 1.73, 95% confidence interval (CI); 1.35 to 2.21, P < .0001), higher stone fragmentation rate (odds ratio; 2.83, 95% CI; 1.30 to 6.16, P = .009), less average number of sessions per stone (mean difference; -0.13; 95% CI, -0.25 to -0.01, P = .03) and similar average number of shocks per stone (mean difference; -126.89; 95% CI, -394.53 to 140.76, P = .35). CONCLUSION This systematic review and meta-analysis indicates that diuretics during extracorporeal SWL was effective in the management of urolithiasis with lower risk of complications.
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Affiliation(s)
- Liying Dong
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
| | - Fengyao Wang
- Department of Urology, Qingdao Third People's Hospital, Qingdao
| | - Hongyan Chen
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
| | - Youyi Lu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
| | - Yong Zhang
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing
| | - Linjing Chen
- Operating Room, The Affiliated YantaiYuhuangding Hospital of Qingdao University, Yantai, Shandong
| | - Yuanshan Cui
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
- Department of Urology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
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Luo X, Jin Q, Wu Y. Tolvaptan add-on therapy in patients with acute heart failure: A systematic review and meta-analysis. Pharmacol Res Perspect 2020; 8:e00614. [PMID: 32500625 PMCID: PMC7272393 DOI: 10.1002/prp2.614] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022] Open
Abstract
This study aimed to investigate the short-term efficacy and safety of tolvaptan as an add-on to traditional diuretics in patients with acute heart failure (AHF). The PubMed, EMBASE, Cochrane Library, and Web of Science databases were comprehensively searched for all randomized controlled trials (RCTs) that examined AHF patients treated with tolvaptan as a combination therapy with traditional diuretics published on or before December 2, 2019. Efficacy indicators such as improved dyspnea, reduced edema, and changes in urine output and body weight were evaluated. In-hospital mortality and worsening renal function (WRF) were measured as safety indicators. Data from the published literature included in this study were independently extracted by two reviewers. The Cochrane risk of bias tool was used to evaluate the quality of the included RCTs. Twelve RCTs involving 5577 patients admitted for AHF were included. Compared with traditional diuretics alone, add-on tolvaptan significantly relieved dyspnea, reduced weight, increased total urine volume and changes in urine volume from baseline, reduced edema, and increased serum sodium concentration in the short term without increasing the mortality. Most importantly, a low dose of tolvaptan (7.5-15 mg/d) significantly reduced the incidence of WRF, while a high dose (30 mg/d) had the opposite effect. Short-term add-on tolvaptan in hospitalized AHF patients could significantly relieve shortness of breath, reduce body weight, improve edema, and increase urine output and serum sodium concentrations without increasing mortality. The protective effects of add-on tolvaptan against WRF, however, were observed at low doses, but not at high doses.
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Affiliation(s)
- Xiandu Luo
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiPeople’s Republic of China
| | - Qi Jin
- Center for Pulmonary Vascular DiseasesNational Center for Cardiovascular DiseasesFuwai HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China
| | - Yanqing Wu
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangJiangxiPeople’s Republic of China
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Miyazaki K, Onuma Y, Komatsu R, Kamono M. Development of Pulmonary Edema Despite Negative Fluid Balance with Diuretics in a Patient with Heart Failure and Sigmoid Septum. Tokai J Exp Clin Med 2020; 45:31-36. [PMID: 32219807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
An 87-year-old man was hospitalized due to dyspnea and leg edema. He was diagnosed with heart failure due to anemia with a hemoglobin (Hb) concentration of 6.0 g/dL. Chest X-ray on admission revealed pleural effusion. He was transfused with 400 mL packed red blood cells, which elevated the Hb concentration to 8.6 g/dL. Spironolactone (25 mg/day) and furosemide (20 mg/day, intravenously) were initiated. Despite the negative fluid balance, the patient's dyspnea worsened. Chest X-ray on day 8 revealed pulmonary edema despite decreased pleural effusion. Transthoracic echocardiography (TTE) revealed a sigmoid-shaped interventricular septum and systolic anterior motion of the mitral valve, causing left ventricular outflow tract obstruction (LVOTO; peak pressure gradient, 96 mmHg). Pilsicainide (75 mg/day) was administered to reduce the LVOTO. In addition, furosemide administration was changed to continuous infusion with increased dose of 48 mg/day (2 mg/h). The patient's dyspnea finally abated, with X-ray on day 12 revealing marked reduction in pulmonary congestion. TTE on day 17 revealed marked reduction in LVOTO (peak pressure gradient, 21 mmHg). Hemodynamic change by diuretics in the setting of right-sided heart failure due to anemia and in the presence of LVOTO due to sigmoid septum could be the cause of pulmonary edema.
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Affiliation(s)
- Koji Miyazaki
- Department of General Internal Medicine, Tokai University School of Medicine, Hachioji Hospital, 1838 Ishikawa-machi, Hachioji, Tokyo 192-0032, Japan.
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Younis W, Schini-Kerth VB, Brentan da Silva D, Junior AG, Bukhari IA, Assiri AM. Role of the NO/cGMP pathway and renin-angiotensin system in the hypotensive and diuretic effects of aqueous soluble fraction from Crataegus songarica K. Koch. J Ethnopharmacol 2020; 249:112400. [PMID: 31739101 DOI: 10.1016/j.jep.2019.112400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 07/22/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
ETHNO-PHARMACOLOGICAL RELEVANCE Fruits of Crataegus songarica K. Koch. (Rosaceae) are commonly used in folk medicine for their diuretic properties to treat hypertension and congestive heart failure. To date, no scientific data has been published to support the diuretic potential. AIM OF THE STUDY The purpose of this study was to evaluate efficacy and mechanism underlying the hypotensive and diuretic action of C. songarica in normotensive rats and to determine the constituents from the extracts by LC-DAD-MS. MATERIALS AND METHODS Firstly, phytochemical profiling and antioxidant potential of C. songarica extracts was determined. Then, to evaluate changes in blood pressure, different groups of anesthetized normotensive rats were intravenously treated with crude extract (CS-Cr, 10-80 mg/kg), aqueous soluble (AS-CS, 0.1-20 mg/kg), and n-butanol soluble fractions of C. songarica (BS-CS, 1-80 mg/kg). The diuretic effects of CS-Cr (100-500 mg/kg, p.o), AS-CS (100-300 mg/kg, p.o) and BS-CS (100-300 mg/kg, p.o) were evaluated in comparison with hydrochlorothiazide (HCTZ, 10 mg/kg, p.o). The urinary volume, sodium, potassium and pH were estimated in the sample collected for 6 h from saline-loaded rats. Using pharmacological antagonists or inhibitors, we determine the involvement of acetylcholine, prostaglandins, and nitric oxide in C. songarica induced hypotensive and diuresis action. In addition, the activities of angiotensin converting enzyme, erythrocytary carbonic anhydrase and renal Na+/K+/ATPase were evaluated in vitro. RESULTS From the LC-DAD-MS analyses, thirty-nine compounds were detected, showing a complex chemical profile and an expressive antioxidant activity "in vitro". Acute treatment with CS-Cr, AS-CS, and BS-CS exhibited significant hypotensive and diuretic potential in normotensive rats. However, AS-CS produced most potent and significant dose-dependent hypotension in normotensive rats, and also produced highly significant diuretic and saluretic effects. Despite the changes in urinary excretion of electrolytes, the plasmatic levels of sodium and potassium were not changed. Previous treatment with atropine and L-NAME significantly reduced the hypotensive and diuretic action of AS-CS in normotensive rats. Moreover, the 7-day treatment with AS-CS also resulted in significant ACE inhibitory activity. CONCLUSION This research supports and extends the ethnomedicinal use of C. songarica as diuretic and hypotensive agent. The results showed that AS-CS from C. songarica could present compounds responsible for hypotensive and diuretic activities with no signs of toxicity, and these effects could involve nitric oxide pathway activated by muscarinic receptors or/and inhibition of angiotensin converting enzyme.
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Affiliation(s)
- Waqas Younis
- Laboratory of Cardiovascular Research and Integrative Pharmacology, College of Pharmacy, University of Sargodha, Sargodha, 40100, Pakistan
| | - V B Schini-Kerth
- UMR CNRS 7213, Laboratory of Biophotonics and Pharmacology, Faculty of Pharmacy, University of Strasbourg, Illkirch, France
| | - Denise Brentan da Silva
- Laboratory of Natural Products and Mass Spectrometry, Federal University of Mato Grosso do Sul, MS, Brazil
| | - Arquimedes Gasparotto Junior
- Laboratory of Electrophysiology and Cardiovascular Pharmacology, Federal University of Grande Dourados (UFGD), P.O. Box 533, 79.804-970, Dourados, MS, Brazil
| | - Ishfaq Ali Bukhari
- Department of Pharmacology, College of Medicine, King Saud University Riyadh, Saudi Arabia
| | - Asaad Mohamed Assiri
- Prince Abdullah Ben Khaled Celiac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Li M, Zhao Y, Zhang S, Xu Y, Wang SY, Li BW, Ran JH, Li RT, Yang BX. A thienopyridine, CB-20, exerts diuretic activity by inhibiting urea transporters. Acta Pharmacol Sin 2020; 41:65-72. [PMID: 31213671 PMCID: PMC7468274 DOI: 10.1038/s41401-019-0245-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/28/2019] [Indexed: 01/08/2023] Open
Abstract
Urea transporters (UTs) are transmembrane proteins selectively permeable to urea and play an important role in urine concentration. UT-knockout mice exhibit the urea-selective urine-concentrating defect, without affecting electrolyte balance, suggesting that UT-B inhibitors have the potential to be developed as novel diuretics. In this study, we characterized a novel compound 5-ethyl-2-methyl-3-amino-6-methylthieno[2,3-b]pyridine-2,5-dicarboxylate (CB-20) with UT inhibitory activity as novel diuretics with excellent pharmacological properties. This compound was discovered based on high-throughput virtual screening combined with the erythrocyte osmotic lysis assay. Selectivity of UT inhibitors was assayed using transwell chambers. Diuretic activity of the compound was examined in rats and mice using metabolic cages. Pharmacokinetic parameters were detected in rats using LC-MS/MS. Molecular docking was employed to predict the potential binding modes for the CB-20 with human UT-B. This compound dose-dependently inhibited UT-facilitated urea transport with IC50 values at low micromolar levels. It exhibited nearly equal inhibitory activity on both UT-A1 and UT-B. After subcutaneous administration of CB-20, the animals showed polyuria, without electrolyte imbalance and abnormal metabolism. CB-20 possessed a good absorption and rapid clearance in rat plasma. Administration of CB-20 for 5 days did not cause significant morphological abnormality in kidney or liver tissues of rats. Molecular docking showed that CB-20 was positioned near several residues in human UT-B, including Leu364, Val367, and so on. This study provides proof of evidence for the prominent diuretic activity of CB-20 by specifically inhibiting UTs. CB-20 or thienopyridine analogs may be developed as novel diuretics.
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Affiliation(s)
- Min Li
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Yan Zhao
- State Key Laboratory of Natural and Biomimetic Drugs, School of pharmaceutical Sciences, Peking University, Beijing, 100191, China
- College of Pharmacy, Inner Mongolia Medical University, Hohhot, 010110, China
| | - Shun Zhang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Yue Xu
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Shu-Yuan Wang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Bo-Wen Li
- State Key Laboratory of Natural and Biomimetic Drugs, School of pharmaceutical Sciences, Peking University, Beijing, 100191, China
| | - Jian-Hua Ran
- Chongqing Medical University, Chongqing, 400016, China
| | - Run-Tao Li
- State Key Laboratory of Natural and Biomimetic Drugs, School of pharmaceutical Sciences, Peking University, Beijing, 100191, China.
| | - Bao-Xue Yang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Pharmacology, School of Basic Medical Sciences, Peking University, Beijing, 100191, China.
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Murakami E, Akamatsu H, Shimokawa T, Wada K, Yamamoto N. Furosemide versus mannitol in Japanese patients with thoracic malignancy who received cisplatin-based chemotherapy using short hydration: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e029057. [PMID: 31831529 PMCID: PMC6924869 DOI: 10.1136/bmjopen-2019-029057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Cisplatin (CDDP) is a key drug for various thoracic malignancies. To avoid renal toxicity of CDDP, mannitol is routinely used, but it sometimes causes phlebitis which damages patients' quality of life. Furosemide is another widely used option for diuresis administered more quickly. To date, previous comparisons of these diuretics have lacked statistical significance owing to study design. We therefore undertake a randomised phase II comparative study of furosemide and mannitol in CDDP-based chemotherapy using short hydration. METHODS AND ANALYSIS This is a two-arm, prospective, randomised, single-centre, open-label phase II study. The primary endpoint is set as the proportion of patients who experienced any grade of 'creatinine increase' using the Common Terminology Criteria for Adverse Events V.4.0, during the first cycle. Secondary endpoints are: the proportion of patients who experienced ≥grade 2 of creatinine increase during the first cycle, any grade and ≥grade 2 of creatinine increase after the completion of fourth cycle, and the proportion of patients with phlebitis. Enrolled in this trial will be 105 patients. ETHICS AND DISSEMINATION This study was approved by the Wakayama Medical University Institutional Review Board on 30 March 2018 study (approval number: 2258). Patients have been enrolled since May 2018. As the study will complete accrual in March 2021, results will be published by 2021. This study will provide important information about the utility of furosemide compared with mannitol to protect against nephrotoxicity. TRIAL REGISTRATION NUMBER UMIN000031910.
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Affiliation(s)
- Eriko Murakami
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Hiroaki Akamatsu
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University Hospital, Wakayama, Japan
| | - Kiyoko Wada
- Department of Nursing, Wakayama Medical University, Wakayama, Japan
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Brown AJ, Cutuli SL, Eastwood GM, Bitker L, Marsh P, Bellomo R. A pilot randomised controlled trial evaluating the pharmacodynamic effects of furosemide versus acetazolamide in critically ill patients. CRIT CARE RESUSC 2019; 21:258-264. [PMID: 31778632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To compare the physiological and biochemical effects of a single intravenous dose of furosemide or acetazolamide in critically ill patients. DESIGN Single centre, pilot randomised controlled trial. SETTING Large tertiary adult intensive care unit (ICU). PARTICIPANTS Twenty-six adult ICU patients deemed to require diuretic therapy. INTERVENTION Single dose of intravenous 40 mg furosemide or 500 mg acetazolamide. MAIN OUTCOME MEASURES Data were collected on urine output, cumulative fluid balance, and serum and urine biochemistry for 6 hours before and 6 hours after diuretic administration. RESULTS Study patients had a median age of 55 years (IQR, 50-66) and median APACHE III score of 44 (IQR, 37-52). Furosemide caused a much greater increase in-urine output and much greater median mass chloride excretion (121.7 mmol [IQR, 81.1-144.6] v 23.3 mmol [IQR, 20.4-57.3]; P < 0.01) than acetazolamide. Furosemide also resulted in a progressively more negative fluid balance while acetazolamide resulted in greater alkalinisation of the urine (change in median urinary pH, +2 [IQR, 1.75-2.12] v 0 [IQR, 0-0.5]; P = 0.02). In keeping with this effect, furosemide alkalinised and acetazolamide acidified plasma (change in median serum pH, +0.03 [IQR, 0.01-0.04] v -0.01 [IQR, -0.04 to 0]; P = 0.01; change in median serum HCO3-, +1.5 mmol/L [IQR, 0.75-2] v -2 mmol/L [IQR, -3 to 0]; P < 0.01). CONCLUSIONS Furosemide is a more potent diuretic and chloriuretic agent than acetazolamide in critically ill patients, and achieves a threefold greater negative fluid balance. Compared with acetazolamide, furosemide acidifies urine and alkalinises plasma. Our findings imply that combination therapy might be a more physiological approach to diuresis in critically ill patients.
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Affiliation(s)
- Alastair Jw Brown
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
| | - Salvatore L Cutuli
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Glenn M Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Laurent Bitker
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Philip Marsh
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
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Roy K, Sharma R, Jana M, Jain V. Life-threatening Hypercalcemia as the First Manifestation of Acute Lymphoblastic Leukemia. Indian Pediatr 2019; 56:972-974. [PMID: 31729331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hypercalcemia of malignancy, usually reported in adults in advanced stages, is rare in children. A 4-year-old boy presented with intermittent episodes of severe hypercalcemia, which improved with intravenous hydration therapy, furosemide and bisphosphonates as the initial manifestation of occult acute lymphoblastic leukemia. Pediatricians should rule out hematological malignancy in patients with severe hypercalcemia.
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Affiliation(s)
- Kakali Roy
- Department of Pediatrics, AIIMS, New Delhi, India
| | - Rajni Sharma
- Department of Pediatrics, AIIMS, New Delhi, India.
| | - Manisha Jana
- Department of Radiology, AIIMS, New Delhi, India
| | - Vandana Jain
- Department of Pediatrics, AIIMS, New Delhi, India
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Kyono Y, Nozu K, Nakagawa T, Takami Y, Fujita H, Ioroi T, Kugo M, Iijima K, Kamiyoshi N. Combination of furosemide and fludrocortisone as a loading test for diagnosis of distal renal tubular acidosis in a pediatric case. CEN Case Rep 2019; 9:81-86. [PMID: 31705302 DOI: 10.1007/s13730-019-00432-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/27/2019] [Indexed: 11/26/2022] Open
Abstract
Renal tubular acidosis (RTA) is a rare disease caused by a defect of urinary acidification. The ammonium chloride loading test is the gold standard method for determining the type of RTA. However, because this test has some side effects (e.g., nausea, vomiting, and stomach discomfort), applying this test for pediatric cases is difficult. Recently, a loading test with the combination of furosemide and fludrocortisone was reported to be an alternative to the ammonium chloride loading test, with 100% sensitivity and specificity in adult's cases. We report the first pediatric case of distal RTA in a patient who was successfully diagnosed by a drug loading test with the combination of furosemide and fludrocortisone without any side effects. We also performed genetic analysis and detected a known pathogenic variant in the SLC4A1 gene. The combination loading test of furosemide and fludrocortisone is a useful and safe diagnostic tool for pediatric cases of RTA.
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Affiliation(s)
- Yuki Kyono
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe, Hyogo, 650-0017, Japan
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Kandai Nozu
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe, Hyogo, 650-0017, Japan
| | - Taku Nakagawa
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Yuichi Takami
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Hideki Fujita
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Masaaki Kugo
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Kobe, Hyogo, 650-0017, Japan
| | - Naohiro Kamiyoshi
- Department of Pediatrics, Japanese Red Cross Society Himeji Hospital, 1-12-1 Shimoteno, Himeji, Hyogo, 670-8540, Japan.
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Liu P, McMenamin ÚC, Spence AD, Johnston BT, Coleman HG, Cardwell CR. Furosemide use and survival in patients with esophageal or gastric cancer: a population-based cohort study. BMC Cancer 2019; 19:1017. [PMID: 31664951 PMCID: PMC6819347 DOI: 10.1186/s12885-019-6242-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 10/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Pre-clinical studies have shown that furosemide slows cancer cell growth by acting on the Na-K-2Cl transporter, particularly for gastric cancer cells. However, epidemiological studies have not investigated furosemide use and mortality in gastroesophageal cancer patients. Consequently, we conducted a population-based study to investigate whether furosemide use is associated with reduced cancer-specific mortality in esophageal/gastric cancer patients. METHODS A cohort of patients newly diagnosed with esophageal or gastric cancer between 1998 and 2013 were identified from English cancer registries and linked to the Clinical Practice Research Datalink to provide prescription records and the Office of National Statistics to provide death data up to September 2015. Time-dependant Cox-regression models were used to calculate hazard ratios (HRs) comparing cancer-specific mortality in furosemide users with non-users. Analyses were repeated restricting to patients with common furosemide indications (heart failure, myocardial infarction, edema or hypertension) to reduce potential confounding. RESULTS The cohort contained 2708 esophageal cancer patients and 2377 gastric cancer patients, amongst whom 1844 and 1467 cancer-specific deaths occurred, respectively. Furosemide use was not associated with reduced cancer-specific mortality overall (adjusted HR in esophageal cancer = 1.28, 95% CI 1.10, 1.50 and in gastric cancer = 1.27, 95% CI 1.08, 1.50) or when restricted to patients with furosemide indications before cancer diagnosis (adjusted HR in esophageal cancer = 1.07, 95% CI 0.88, 1.30 and in gastric cancer = 1.18, 95% CI 0.96, 1.46). CONCLUSIONS In this large population-based cohort study, furosemide was not associated with reduced cancer-specific mortality in patients with esophageal or gastric cancer.
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Affiliation(s)
- Peipei Liu
- Centre for Public Health, Queen’s University Belfast, Institute for Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Belfast, Northern Ireland BT12 6BJ UK
| | - Úna C. McMenamin
- Centre for Public Health, Queen’s University Belfast, Institute for Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Belfast, Northern Ireland BT12 6BJ UK
| | - Andrew D. Spence
- Centre for Public Health, Queen’s University Belfast, Institute for Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Belfast, Northern Ireland BT12 6BJ UK
- Belfast Health and Social Care Trust, Belfast, Northern Ireland UK
| | | | - Helen G. Coleman
- Centre for Public Health, Queen’s University Belfast, Institute for Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Belfast, Northern Ireland BT12 6BJ UK
- Centre for Cancer Research and Cell Biology, Queen’s University Belfast, Belfast, Northern Ireland UK
| | - Chris R. Cardwell
- Centre for Public Health, Queen’s University Belfast, Institute for Clinical Science, Royal Victoria Hospital, Grosvenor Road, Belfast, Belfast, Northern Ireland BT12 6BJ UK
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Agarwal R, Rossignol P, Romero A, Garza D, Mayo MR, Warren S, Ma J, White WB, Williams B. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet 2019; 394:1540-1550. [PMID: 31533906 DOI: 10.1016/s0140-6736(19)32135-x] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 08/02/2019] [Accepted: 08/07/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Spironolactone is effective at reducing blood pressure in patients with uncontrolled resistant hypertension. However, the use of spironolactone in patients with chronic kidney disease can be restricted by hyperkalaemia. We evaluated use of the potassium binder patiromer to allow more persistent use of spironolactone in patients with chronic kidney disease and resistant hypertension. METHODS In this phase 2 multicentre, randomised, double-blind, placebo-controlled study, we enrolled participants aged 18 years and older with chronic kidney disease (estimated glomerular filtration rate 25 to ≤45 mL/min per 1·73 m2) and uncontrolled resistant hypertension from 62 outpatient centres in ten countries (Bulgaria, Croatia, Georgia, Hungary, Ukraine, France, Germany, South Africa, the UK, and the USA). Patients meeting all eligibility criteria at the final screening visit were stratified by local serum potassium measurement (4·3 to <4·7 mmol/L vs 4·7 to 5·1 mmol/L) and history of diabetes. Participants were randomly assigned (1:1) with an interactive web response system to receive either placebo or patiromer (8·4 g once daily), in addition to open-label spironolactone (starting at 25 mg once daily) and their baseline blood pressure medications. Participants, the study team that administered treatments and measured blood pressure, and the investigators were masked to assigned treatment groups. Dose titrations were permitted after 1 week (patiromer) and 3 weeks (spironolactone). The primary endpoint was the between-group difference at week 12 in the proportion of patients on spironolactone. Efficacy endpoints and safety were assessed in all randomised patients (intention to treat). The study was registered with Clinicaltrials.gov, NCT03071263. FINDINGS Between Feb 13, 2017, and Aug 20, 2018, we screened 574 patients. 295 (51%) of 574 patients met all inclusion criteria and were randomly assigned to spironolactone in addition to double-blind treatment with either placebo (n=148) or patiromer (n=147). At week 12, 98 (66%) of 148 patients in the placebo group and 126 (86%) of 147 patients in the patiromer group remained on spironolactone (between-group difference 19·5%, 95% CI 10·0-29·0; p<0·0001). Adverse events were mostly mild or moderate in severity and occurred in 79 (53%) of 148 patients in the placebo group and 82 (56%) of 147 patients in the patiromer group. INTERPRETATION In patients with resistant hypertension and chronic kidney disease, patiromer enabled more patients to continue treatment with spironolactone with less hyperkalaemia. Persistent spironolactone enablement in this population of patients has clinical relevance for the treatment of resistant hypertension. FUNDING Relypsa, a Vifor Pharma Group Company.
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Affiliation(s)
- Rajiv Agarwal
- Department of Medicine, Division of Nephrology, Indiana University and Richard L Roudebush VA Medical Center, Indianapolis, IN, USA.
| | - Patrick Rossignol
- University of Lorraine, Institut National de la Santé et de la Recherche Médicale (Inserm) 1433 CIC-P CHRU de Nancy, Inserm U1116 and French Clinical Research Infrastructure Network INI-CRCT, Nancy, France
| | - Alain Romero
- Medical Affairs, Relypsa, a Vifor Pharma Group Company, Redwood City, CA, USA
| | - Dahlia Garza
- Clinical Development, Relypsa, a Vifor Pharma Group Company, Redwood City, CA, USA
| | - Martha R Mayo
- Clinical Development, Relypsa, a Vifor Pharma Group Company, Redwood City, CA, USA
| | - Suzette Warren
- Clinical Development, Relypsa, a Vifor Pharma Group Company, Redwood City, CA, USA
| | - Jia Ma
- Biometrics, Relypsa, a Vifor Pharma Group Company, Redwood City, CA, USA
| | - William B White
- Calhoun Cardiology Center, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Bryan Williams
- Institute of Cardiovascular Sciences University College London (UCL) and National Institute for Health Research UCL/UCL Hospitals Biomedical Research Centre, London, UK
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Wang AS, Dhillon NK, Linaval NT, Rottler N, Yang AR, Margulies DR, Ley EJ, Barmparas G. The Impact of IV Electrolyte Replacement on the Fluid Balance of Critically Ill Surgical Patients. Am Surg 2019; 85:1171-1174. [PMID: 31657318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Avoiding excess fluid administration is necessary when managing critically ill surgical patients. The aim of this study was to delineate the current practices of IV electrolyte (IVE) replacement in a surgical ICU and quantify their contribution to the fluid balance (FB) status. Patients admitted to the surgical ICU over a six-month period were reviewed. Patients undergoing dialysis and those with ICU stay <72 hours were excluded. A total of 248 patients were included. The median age was 60 years, and 57 per cent were male. Overall, 1131 patient ICU days were analyzed. The median daily FB was 672 mL. IVEs were administered in 62 per cent of ICU days. In days that IVEs were used, negative FB was significantly less likely to be achieved (62% vs 69%, P = 0.02). The most commonly administered IVE was calcium (32% of ICU days); however, the largest volume of IVE was administered in the form of phosphorus (median 225 mL). Diuretics were administered in 17 per cent of ICU days. Patients who received diuretics were significantly more likely to receive IVE (70% vs 61%, P = 0.02). Administration of IVE may contribute to the daily positive FB of surgical ICU patients. Implementation of practices that can ameliorate this effect is encouraged.
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Miserachs M, Lurz E, Levman A, Ghanekar A, Cattral M, Ng V, Grant D, Avitzur Y. Diagnosis, Outcome, and Management of Chylous Ascites Following Pediatric Liver Transplantation. Liver Transpl 2019; 25:1387-1396. [PMID: 31301267 PMCID: PMC7165704 DOI: 10.1002/lt.25604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/25/2019] [Indexed: 12/13/2022]
Abstract
Data on postoperative chylous ascites (CA) after pediatric liver transplantation (LT) are scarce. This retrospective study was conducted to identify the incidence, risk factors, management, and outcomes of postoperative CA in a large single-center pediatric LT cohort (2000-2016). The study cohort comprised 317 LTs (153 living donors and 164 deceased donors) in 310 recipients with a median age of 2.7 years. The incidence of CA was 5.4% (n = 17), diagnosed after a median time of 10 days after LT. Compared with chylomicron detection in peritoneal fluid (the gold standard), a triglyceride cutoff value of 187 mg/dL in peritoneal fluid showed insufficient sensitivity (31%) for CA diagnosis. In univariate logistic regression analyses, ascites before LT, younger age, and lower weight, height, and height-for-age z score at LT were associated with CA. Symptomatic management of CA included peritoneal drain (100%) and diuretics (76%). Therapeutic interventions included very low-fat or medium-chain triglyceride-rich diets (94%) and intravenous octreotide (6%), leading to CA resolution in all patients. CA was associated with prolonged hospital length of stay (LOS; 40 days in the CA group versus 24 days in the non-CA group; P = 0.001) but not with reduced patient or graft survival rates after a median follow-up time of 14 years. In conclusion, CA in the pediatric LT recipient is a relatively uncommon complication associated with increased hospital LOS and morbidity. Measurement of chylomicrons is recommended in patients with ascites that is more severe or persistent than expected. Dietary interventions are effective in most patients.
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Affiliation(s)
- Mar Miserachs
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
- Universitat Autònoma de BarcelonaBellaterraSpain
| | - Eberhard Lurz
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and Nutritionvon Haunersches Kinderspitak, Ludwig Maximillians University MunichMunichGermany
| | - Aviva Levman
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
| | - Anand Ghanekar
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Mark Cattral
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Vicky Ng
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
| | - David Grant
- Multi‐Organ Transplant ProgramUniversity Health NetworkTorontoOntarioCanada
- Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Yaron Avitzur
- Transplant and Regenerative Medicine CentreHospital for Sick ChildrenTorontoOntarioCanada
- Division of Pediatric Gastroenterology, Hepatology and NutritionHospital for Sick Children, University of TorontoTorontoOntarioCanada
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Bayly W, Lopez C, Sides R, Bergsma G, Bergsma J, Gold J, Sellon D. Effect of different protocols on the mitigation of exercise-induced pulmonary hemorrhage in horses when administered 24 hours before strenuous exercise. J Vet Intern Med 2019; 33:2319-2326. [PMID: 31397944 PMCID: PMC6766505 DOI: 10.1111/jvim.15574] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 07/10/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Public pressure exists in the United States to eliminate race-day furosemide administration despite its efficacy in decreasing the severity of equine exercise pulmonary hemorrhage (EIPH). No effective alternative prophylaxis strategies have been identified. OBJECTIVE To investigate alternative protocols to race-day furosemide that might mitigate EIPH. ANIMALS Seven fit Thoroughbreds with recent EIPH. METHODS Double-blinded placebo-controlled Latin square crossover using a treadmill followed by a blinded placebo-controlled crossover study at a racetrack. First, horses exercised supramaximally to fatigue 24 hours after initiating 5 EIPH prophylaxis protocols: 0.5 and 1.0 mg/kg furosemide IV 24 hours pre-exercise with and without controlled access to water, and 24 hour controlled access to water. Effects were compared to those measured after giving a placebo 24 hours pre-exercise, and 0.5 mg/kg furosemide IV 4 hours pre-exercise. Bronchoalveolar lavage (BAL) erythrocyte count was determined 45-60 minutes postexercise after endoscopy to assign an EIPH score. Data were analyzed using linear mixed effects models. The most promising protocol from the treadmill study was further evaluated in 6 horses using endoscopy and BAL after 1100 m simulated races. RESULTS Intravenous furosemide (0.5 mg/kg) administered 24 hours pre-exercise combined with controlled access to water decreased the severity of EIPH on the treadmill and at the racetrack. CONCLUSION AND CLINICAL IMPORTANCE Administering 0.5 mg/kg furosemide 24 hours pre-racing combined with controlling water intake may be a strategy to replace race-day furosemide administration for the management of EIPH. A larger study is indicated to further evaluate whether this protocol significantly mitigates EIPH severity.
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Affiliation(s)
- Warwick Bayly
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | - Carolina Lopez
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | - Raymond Sides
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | | | | | - Jenifer Gold
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
| | - Debra Sellon
- Department of Veterinary Clinical Sciences, Washington State University, Pullman, Washington
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Tian W, Huang Q, Yao Z, Huang M, Yang F, Zhao Y, Li J. A preliminary prospective study of patients who underwent vacuum-assisted and mesh-mediated fascial traction techniques for open abdomen management with negative fluid therapy: An observational study. Medicine (Baltimore) 2019; 98:e16617. [PMID: 31464898 PMCID: PMC6736416 DOI: 10.1097/md.0000000000016617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
It is unclear whether strategies targeting negative fluid balance are associated with facilitated early fascial closure. The present study investigated the effects of fluid removal therapy on early facial closure of open abdomen patients.A prospective study was conducted in patients who underwent open abdomen management with vacuum-assisted and mesh-mediated fascial traction technique. Therapeutic diuresis with torasemide was applied to cause negative fluid balance in the treatment group. The study and follow-up periods were 7 and 180 days, respectively. The observational indices included the intra-abdominal pressure, the number of days to closure, the type of closure, the septic complications, the duration of ventilation support, the duration of initial hospital stay, and the duration of intensive care unit (ICU) stay.A total of 27 patients were divided into the treatment (16 patients) and control (11 patients) groups. The median intra-abdominal pressure (IAP) of the patients of the control and the treatment groups was significantly lower at day 7 compared with the baseline value (P < .0001). IAP was lower in the treatment group compared with that noted in the control group, following day 4 of the fluid removal therapy (P < .05). The percentage weight loss in the treatment group was between 4.80% and 10.88%. The early closure rates were significantly higher in the treatment group compared with those in the control group (75.0% vs 18.2%, P = .0063).Fluid removal therapy combined with vacuum-assisted and mesh-mediated fascial traction provided a high early fascial closure rate for open abdomen patients.
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Affiliation(s)
- Weiliang Tian
- Department of Surgery, Jinling Hospital, Nanjing, China
| | - Qian Huang
- Department of Surgery, Jinling Hospital, Nanjing, China
| | - Zheng Yao
- Department of Surgery, Jiangning Hospital, Nanjing, China
| | - Ming Huang
- Department of Surgery, Jiangning Hospital, Nanjing, China
| | - Fan Yang
- Department of Surgery, Jinling Hospital, Nanjing, China
| | - Yunzhao Zhao
- Department of Surgery, Jinling Hospital, Nanjing, China
| | - Jieshou Li
- Department of Surgery, Jinling Hospital, Nanjing, China
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Weeda ER, Cassarly C, Brinton DL, Shirley DW, Simpson KN. Loop diuretic use among patients with heart failure and type 2 diabetes treated with sodium glucose cotransporter-2 inhibitors. J Diabetes Complications 2019; 33:567-571. [PMID: 31176543 PMCID: PMC6613996 DOI: 10.1016/j.jdiacomp.2019.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 04/19/2019] [Accepted: 05/05/2019] [Indexed: 01/14/2023]
Abstract
AIMS To compare loop diuretic use in patients with comorbid heart failure (HF) and type 2 diabetes (T2D) newly initiated on sodium glucose cotransporter-2 inhibitors (SGLT2Is) versus other oral anti-glycemic agents (AGAs). METHODS This analysis used 2013-2015 MarketScan Medicare Supplemental claims data. HF and T2D patients were identified and SGLT2I users were propensity score matched to other AGA users. The mean daily dose of loop diuretics in furosemide equivalents was ascertained. For those not on baseline loop diuretics, new use was compared between cohorts. For those on baseline loop diuretics, we assessed patterns of use (increased dose, decreased dose, stable dose, no longer using) at 12-months. RESULTS A total of 750 SGLT2I users were matched to 750 other AGA users. The distribution of loop diuretic use at mean doses of 0 mg (i.e., no use), ≤20 mg, >20 mg-40 mg, >40 mg-80 mg and >80 mg/day did not differ between cohorts at baseline or 12-months (p > 0.05 for both). SGLT2I use was associated with less new loop diuretic use (22.7% [79/348] vs. 34.0% [132/388]; p = 0.001). For those on loop diuretics at baseline (n = 764), patterns of use at 12-months did not differ between cohorts (p = 0.14). CONCLUSIONS New loop diuretic use was less frequent among SGLT2I users; however, patterns of loop diuretic use did not differ between cohorts in those on loop diuretics at baseline.
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Affiliation(s)
- Erin R Weeda
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA.
| | - Christy Cassarly
- Department of Otolaryngology - Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA; Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Daniel L Brinton
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
| | - David W Shirley
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Kit N Simpson
- Department of Healthcare Leadership & Management, College of Health Professions, Medical University of South Carolina, Charleston, SC 29425, USA
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Brito-Azevedo A. Diuretic window hypothesis in cirrhosis: Changing the point of view. World J Gastroenterol 2019; 25:3283-3290. [PMID: 31341355 PMCID: PMC6639551 DOI: 10.3748/wjg.v25.i26.3283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 05/09/2019] [Accepted: 06/01/2019] [Indexed: 02/06/2023] Open
Abstract
Since the 1970s, non-selective beta-blockers (NSBB) have been used to prevent variceal upper bleeding in advanced cirrhotic patients. However, several recent studies have raised the doubt about the benefit of NSBB in end-stage cirrhotic patients. In fact, they suggested a detrimental effect in these patients that even reduced survival. All of these studies have been assembled to compose the “window therapy hypothesis”, in which NSBB would have traditional indication to be initiated to prevent variceal upper bleeding; however, treatment should be stopped (or not be initiated) in patients with end-stage cirrhosis. NSBB would reduce the cardiac reserve of these patients, worsening systemic perfusion and prognosis. However, it should be emphasized that these studies present important bias issues, and their results also suggested that diuretic treatment may also be behind the effects observed. In this opinion review, we changed the point of view from NSBB to diuretic treatment, based on a physiopathogenic approach of circulatory parameters of cirrhotic patients studied, and based on diuretic effect in blood pressure lowering and in other hypervolemic disease, as heart failure. We suggest a “diuretic window hypothesis”, composed by an open window in hypervolemic phase, an attention window when patient present in a normal plasma volume phase, and a closed window during the plasma hypovolemic phase.
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Affiliation(s)
- Anderson Brito-Azevedo
- Liver Transplant Unit, São Lucas Hospital, Rio de Janeiro 22061-080, Brazil
- Liver Transplant Unit, São Francisco na Providência de Deus Hospital, Rio de Janeiro 20520-053, Brazil
- Liver Transplant Unit, Adventist Silvestre Hospital, Rio de Janeiro 22241-280, Brazil
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Naci H, Salcher-Konrad M, Dias S, Blum MR, Sahoo SA, Nunan D, Ioannidis JPA. How does exercise treatment compare with antihypertensive medications? A network meta-analysis of 391 randomised controlled trials assessing exercise and medication effects on systolic blood pressure. Br J Sports Med 2019; 53:859-869. [PMID: 30563873 DOI: 10.1136/bjsports-2018-099921] [Citation(s) in RCA: 172] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To compare the effect of exercise regimens and medications on systolic blood pressure (SBP). DATA SOURCES Medline (via PubMed) and the Cochrane Library. ELIGIBILITY CRITERIA Randomised controlled trials (RCTs) of angiotensin-converting enzyme inhibitors (ACE-I), angiotensin-2 receptor blockers (ARBs), β-blockers, calcium channel blockers (CCBs) and diuretics were identified from existing Cochrane reviews. A previously published meta-analysis of exercise interventions was updated to identify recent RCTs that tested the SBP-lowering effects of endurance, dynamic resistance, isometric resistance, and combined endurance and resistance exercise interventions (up to September 2018). DESIGN Random-effects network meta-analysis. OUTCOME Difference in mean change from baseline SBP between comparator treatments (change from baseline in one group minus that in the other group) and its 95% credible interval (95% CrI), measured in mmHg. RESULTS We included a total of 391 RCTs, 197 of which evaluated exercise interventions (10 461 participants) and 194 evaluated antihypertensive medications (29 281 participants). No RCTs compared directly exercise against medications. While all medication trials included hypertensive populations, only 56 exercise trials included hypertensive participants (≥140 mmHg), corresponding to 3508 individuals. In a 10% random sample, risk of bias was higher in exercise RCTs, primarily due to lack of blinding and incomplete outcome data. In analyses that combined all populations, antihypertensive medications achieved higher reductions in baseline SBP compared with exercise interventions (mean difference -3.96 mmHg, 95% CrI -5.02 to -2.91). Compared with control, all types of exercise (including combination of endurance and resistance) and all classes of antihypertensive medications were effective in lowering baseline SBP. Among hypertensive populations, there were no detectable differences in the SBP-lowering effects of ACE-I, ARB, β-blocker and diuretic medications when compared with endurance or dynamic resistance exercise. There was no detectable inconsistency between direct and indirect comparisons. Although there was evidence of small-study effects, this affected both medication and exercise trials. CONCLUSIONS The effect of exercise interventions on SBP remains under-studied, especially among hypertensive populations. Our findings confirm modest but consistent reductions in SBP in many studied exercise interventions across all populations but individuals receiving medications generally achieved greater reductions than those following structured exercise regimens. Assuming equally reliable estimates, the SBP-lowering effect of exercise among hypertensive populations appears similar to that of commonly used antihypertensive medications. Generalisability of these findings to real-world clinical settings should be further evaluated.
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Affiliation(s)
- Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Sofia Dias
- Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
| | - Samali Anova Sahoo
- Department of Life Sciences and Management, The Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David Nunan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John P A Ioannidis
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, California, USA
- Stanford Prevention Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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Lozano Bahamonde A, Escolar Pérez V, Echebarria Chousa A, Azcona Lucio A, Alfambra Vicente S, Rodríguez Rodríguez B. Subcutaneous Furosemide in Patients With Refractory Heart Failure. Rev Esp Cardiol (Engl Ed) 2019; 72:500-502. [PMID: 30029975 DOI: 10.1016/j.rec.2018.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 04/27/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Ainara Lozano Bahamonde
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain.
| | - Vanessa Escolar Pérez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain
| | - Amaia Echebarria Chousa
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain
| | - Alberto Azcona Lucio
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain
| | - Silvia Alfambra Vicente
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain
| | - Begoña Rodríguez Rodríguez
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Basurto, Organización Sanitaria Integrada Bilbao Basurto, Vizcaya, Spain
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Abstract
Background: Heart failure (HF) is a common, serious disease in the US and Europe. Patients with HF often require treatment for fluid overload, resulting in costly inpatient visits; however, limited evidence exists on the costs of alternative treatments. This study performed a cost-analysis of ultrafiltration (UF) vs diuretic therapy (DIUR-T) for patients with HF from the hospital perspective. Methods: The model used clinical data from the literature and hospital data from the Healthcare Cost and Utilization Project to follow a decision-analytic framework reflecting treatment decisions, probabilistic outcomes, and associated costs for treating patients with HF and hypervolemia with veno-venous UF or intravenous DIUR-T. A 90-day timeframe was considered to account for hospital readmissions beyond 30 days. Sensitivity and scenario analyses were performed to gauge the robustness of the results. Results: Although initial hospitalization costs were higher, fluid removal by UF reduced hospital readmission days, leading to cost savings of $3,975 (14.4%) at the 90-day follow-up (UF costs, $23,633; DIUR-T costs, $27,608). Conclusions: UF is a viable alternative to DIUR-T when treating fluid overload in HF patients because it reduces hospital readmission rates and durations, which substantially lowers costs over a 90-day period compared to DIUR-T.
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Affiliation(s)
| | - Gregg C Fonarow
- b University of California Los Angeles , Los Angeles , CA , USA
| | - John A Rizzo
- c Stony Brook University , Stony Brook , NY , USA
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Nam YH, Bilker WB, Leonard CE, Bell ML, Hennessy S. Outdoor temperature and survival benefit of empiric potassium in users of furosemide in US Medicaid enrollees: a cohort study. BMJ Open 2019; 9:e023809. [PMID: 30777859 PMCID: PMC6398730 DOI: 10.1136/bmjopen-2018-023809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Heat is associated with elevated all-cause mortality, and furosemide-induced potassium depletion might be worsened by heat-induced sweating. Because empiric potassium is associated with a marked survival benefit in users of furosemide at a dose of ≥40 mg/day, we hypothesised that this empiric potassium's survival benefit would increase with higher temperature (≥24°C). DESIGN Cohort study. SETTING Outpatient setting, captured by Medicaid claims, supplemented with Medicare claims for dual enrollees, from 5 US states from 1999 to 2010, linked to meteorological data. POPULATION/PARTICIPANTS Furosemide (≥40 mg/day) initiators among adults continuously enrolled in Medicaid for at least 1 year prior to cohort entry (defined as the day following the dispensing day of each individual's first observed furosemide prescription). EXPOSURE Interaction between: (1) empiric potassium, dispensed the day of or the day following the dispensing of the initial furosemide prescription, and (2) daily average temperature and daily maximum temperature, examined separately. OUTCOME All-cause mortality. RESULTS In 1:1 propensity score matched cohorts (total n=211 878) that included 89 335 person-years and 9007 deaths, all-cause mortality rates per 1000 person-years were 96.0 (95% CI 93.2 to 98.9) and 105.8 (95% CI 102.8 to 108.9) for potassium users and non-users, respectively. The adjusted OR of all-cause mortality for potassium use declined (ie, its apparent protective effect increased) as temperature increased, from a daily average temperature of about 28°C and a daily maximum temperature of about 31°C. This relationship was not statistically significant with daily average temperature, but was statistically significant with daily maximum temperature (p values for the interaction of potassium with daily maximum temperature and daily maximum temperature squared were 0.031 and 0.028, respectively). CONCLUSIONS The results suggest that empiric potassium's survival benefit among furosemide (≥40 mg/day) initiators may increase as daily maximum temperature increases. If this relationship is real, use of empiric potassium in Medicaid enrollees initiating furosemide might be particularly important on hot days.
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Affiliation(s)
- Young Hee Nam
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B Bilker
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Charles E Leonard
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle L Bell
- School of Forestry & Environmental Studies, Yale University, New Haven, Connecticut, USA
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research and Training, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics, Epidemiology and Informatics, Perelman of School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Clark JE, de la Fuente J, Hafdahl LT. 66-Year-Old Man With Light-headedness, Chest Pain, and Dyspnea. Mayo Clin Proc 2019; 94:e13-e17. [PMID: 30711140 DOI: 10.1016/j.mayocp.2018.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/07/2018] [Accepted: 04/11/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Jennifer E Clark
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Jaime de la Fuente
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Luke T Hafdahl
- Advisor to residents and Consultant in Community Internal Medicine, Mayo Clinic, Rochester, MN.
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Macfarlane TV, Pigazzani F, Flynn RW, MacDonald TM. The effect of indapamide vs. bendroflumethiazide for primary hypertension: a systematic review. Br J Clin Pharmacol 2019; 85:285-303. [PMID: 30312512 PMCID: PMC6339968 DOI: 10.1111/bcp.13787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/25/2018] [Accepted: 09/21/2018] [Indexed: 12/28/2022] Open
Abstract
The aims of the current review were to compare the efficacy of monotherapy with bendroflumethiazide vs. indapamide on mortality, cardiovascular outcomes, blood pressure, need for intensification of treatment and treatment withdrawal. Two authors independently screened the results of a literature search, assessed the risk of bias and extracted relevant data. Randomized clinical trials of hypertensive patients of at least a 1-year duration were included. When there was disagreement, a third reviewer was consulted. Risk ratio (RR) and mean differences were used as measures of effect. Two trials comparing bendroflumethiazide against placebo, one comparing indapamide with placebo and three of short duration directly comparing indapamide and Bendroflumethiazide, were included. No statistically significant difference was found between indapamide and bendroflumethiazide for all deaths [RR 0.82; 95% confidence interval (CI) 0.57, 1.18], cardiovascular deaths (RR 0.82; 95% CI 0.55, 1.20), noncardiovascular deaths (0.81; 95% CI 0.54, 1.22), coronary events (RR 0.73; 95% CI 0.30, 1.79) or all cardiovascular events (RR 0.89; 95% CI 0.67, 1.18). Indapamide performed worse for stroke (RR 2.21; 95% CI 1.19, 4.11), even though a reduction in RR compared with placebo was observed in both groups. There was no statistically or clinically significant difference between indapamide and bendroflumethiazide in blood pressure reduction (mean absolute difference <1 mmHg). The present review highlights a lack of studies to answer the review question but also a lack of evidence of superiority of one drug over the other. Therefore, there is a clear need for new studies directly comparing the effect of these drugs on the outcomes of interest.
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Affiliation(s)
| | - Filippo Pigazzani
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
| | - Robert W.V. Flynn
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
| | - Thomas M. MacDonald
- Medicines Monitoring Unit (MEMO), School of MedicineUniversity of DundeeDundeeUK
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